Lung cancer at the intensive care unit: The era of targeted therapy

Lung cancer is the most common solid tumor that requires admission to an intensive care unit (ICU). The overall perception about the value of ICU admission for lung cancer patients remains negative, given the poor overall prognosis of patients with advanced lung cancer. Recently developed highly effective targeted therapies for lung cancers with an oncogene driver have an expected rapid onset of action and a decreased risk of toxicity. Therefore, ICU care for lung cancer patients has to be reconsidered. We present an illustrative case of a young woman with stage IV ALK-translocated pulmonary adenocarcinoma. Her disease dramatically worsened while waiting for central confirmation of the ALK-translocation to start treatment in a clinical trial with ceritinib, a 2nd generation ALK tyrosine kinase inhibitor. She needed mechanical ventilation and veno-venous extracorporal membranous oxygenation, to have sufficient time to recover from overwhelming bilateral lung adenocarcinoma, while on treatment. She is now doing fine 1 year later.