Immunotherapy on ICU: a narrative review.

Area of Science:

• Oncology
• Immunotherapy
• Critical Care Medicine

Background:

• Cancer patients represent 15% of critical care admissions.
• Chimeric antigen receptor (CAR) T-cell therapy and immune checkpoint inhibitors (ICIs) have improved cancer prognoses.
• Understanding treatment complications is vital for intensive care clinicians.

Purpose of the Study:

• To provide non-specialists with an understanding of CAR T-cell therapy and ICI-related toxicities.
• To review the pathophysiology, diagnosis, and management of these complications.
• To highlight current concepts in managing immunotherapy-induced adverse events.

Main Methods:

• Searched electronic databases for peer-reviewed publications.
• Included basic science, clinical trials, cohort studies, systematic reviews, meta-analyses, and guidelines.
• Screened abstracts for relevance to immune effector cell toxicities and immune-related adverse events.

Main Results:

• Pathophysiology of CAR T-cell and ICI toxicities is not fully understood.
• Targeted therapies, like those for cytokine release syndrome, are effective.
• Corticosteroids are key in management; diagnosis is often clinical; infective complications require vigilance.

Conclusions:

• Understanding of immunotherapy toxicity mechanisms is limited, hindering predictive models and biomarkers.
• Further research is needed to develop treatments that minimize corticosteroid use.
• Management requires collaboration between critical care and oncology specialists.