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Collectively, these findings support the view that neuroinflammation is not merely an epiphenomenon of depression but a driving force that integrates immune activation with neurotransmitter imbalance, impaired neuroplasticity, and stress-related neuroendocrine dysregulation (30, 31)

Also, chronic circadian misalignment leads to immune suppression and low-grade systemic inflammation, both of which contribute to impaired tumor immunosurveillance 146

Advise females of reproductive potential to use effective contraception during treatment with pemetrexed and for 6 months after the final dose