Letter to the Editor
Complexity and uncertainty in the critical care of cancer patients in the era of immunotherapy and targeted therapies
Complejidad e incertidumbre en cuidados críticos para pacientes con cáncer en la era de la inmunoterapia y terapias dirigidas
A. Carmona-Bayonasa,
, F. Gordob, C. Beatoc, J. Castaño Pèc)rezd, P. Jimèc)nez-Fonsecae, J. Virizuela Echaburuc, J. Garnacho-Monterof
Corresponding author
a Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain
b Intensive Care Department, Hospital Universitario del Henares (Coslada-Madrid); Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
c Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
d Intensive Care Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
e Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
f Intensive Care Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
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Carmona-Bayonas, F. Gordo, C. Beato, J. Castaño Pèc)rez, P. Jimèc)nez-Fonseca, J. Virizuela Echaburu, J. Garnacho-Montero" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Carmona-Bayonas" "email" => array:1 [ 0 => "alberto.carmonabayonas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Gordo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Beato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." 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"apellidos" => "Garnacho-Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario del Henares (Coslada-Madrid); Grupo de investigación en patología crítica, Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Intensive Care Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complejidad e incertidumbre en cuidados críticos para pacientes con cáncer en la era de la inmunoterapia y terapias dirigidas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have carefully read the letter from Illescas-Vacas et al. regarding SEOM-SEMICYUC's commitment to optimize the care of cancer patients admitted to Intensive Care Units.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> We agree with the authors that radiotherapy has evolved with important technological advances in recent years, with more precise, effective and less toxic treatments that contribute to improve survival. Likewise, radiotherapy, in general, is associated with low acute potential toxicity if administered in monotherapy, without concomitant systemic treatment. On the contrary, systemic cancer treatments, chemotherapy, anti-target agents and immunotherapy, among others, have made it possible for a group of patients with advanced disease becoming long-term survivors. Nevertheless, these drugs not only bring new opportunities for patients, but also new challenges and toxicities, creating greater complexity and uncertainty in the field of critical care. In the previous decade, when the prognosis was universally bleak, decision-making was simple, the only solution often being palliative care. However, admission and support in the Intensive Care Unit of a patient with metastatic cancer may currently be justified if it is known that his tumor expresses a target for which specific treatment is available. In addition, a patient with advanced cancer who develops severe toxicity while receiving immunotherapy may require advanced supportive care if a tumor response has been confirmed. These oncological situations and emergencies, which are increasingly common nowadays, have led the SEOM-SEMICYUC team to develop an informative document in which they comment on the oncological scenarios and treatments that are most associated with an acute or emergency condition, something that is especially common in advanced cancers with systemic treatments. This paper shows the two great challenges that technology is imposing on clinical decision making: (1) to correctly transmit information between professionals on individualized prognosis, sometimes based on complex biomarkers,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> (2) to assume that sometimes we will have lost our ability to identify which patients are going to be long-term survivors, so we will be required to provide many of them with adequate support.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0010" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuidados intensivos de pacientes oncológicos en la era del tratamiento multidisciplinar: la perspectiva desde la oncología radioterápica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Illescas-Vacas" 1 => "N. Abu-Omar" 2 => "C. Míguez" 3 => "E. Bayo-Lozano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care in cancer patients in the age of immunotherapy and molecular therapies: commitment of the SEOM-SEMICYUC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carmona-Bayonas" 1 => "F. Gordo" 2 => "C. Beato" 3 => "J. Castaño Pèc)rez" 4 => "P. Jimèc)nez-Fonseca" 5 => "J. Virizuela Echaburu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crizotinib in ROS1 • rearranged non-small-cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.T. Shaw" 1 => "S.-H.I. Ou" 2 => "Y.-J. Bang" 3 => "D.R. Camidge" 4 => "B.J. Solomon" 5 => "R. Salgia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1406766" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "371" "paginaInicial" => "1963" "paginaFinal" => "1971" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25264305" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.S. Herbst" 1 => "P. Baas" 2 => "D.-W. Kim" 3 => "E. Felip" 4 => "J.L. Pèc)rez-Gracia" 5 => "J.-Y. Han" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)01281-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "387" "paginaInicial" => "1540" "paginaFinal" => "1550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26712084" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000009/v1_201811250605/S217357271830208X/v1_201811250605/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000009/v1_201811250605/S217357271830208X/v1_201811250605/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271830208X?idApp=WMIE" ]
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