Immunotherapy in the critically ill cancer patient: What the intensivist should know

Immunotherapy has produced a revolution in the treatment of cancer. It involves manipulating the patient's immune system to identify and destroy malignant cells. There has been an explosion in the development of these therapies in recent decades, with the emergence of monoclonal and bispecific antibodies, immune checkpoint inhibitors, and cellular therapies, including T cells modified with a chimeric antigen receptor (CAR-T cells) and tumor-infiltrating lymphocytes (TILs). While these new therapies offer new hope to patients, they have also introduced a new profile of adverse effects, resulting from the action of a hyperactive immune system, such as infusion reactions, autoimmune phenomena, cytokine release syndrome, and neurotoxicity associated with immune effector therapies, as well as capillary leak syndrome.