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Multicenter Study
. 2025 May;104(5):2937-2946.
doi: 10.1007/s00277-025-06400-3. Epub 2025 May 10.

Targeted antineoplastic therapy in critically ill cancer patients: a multicenter analysis of the iCHOP registry

Anthea Storck  1 , Gernot Beutel  2 , Matthias Kochanek  1 , Peter Schellongowski  3 , Thomas Staudinger  3 , Nina Buchtele  3 , Julia Cserna  4 , Nicole Brueder  2 , Catherina Lueck  2 , Tobias Liebregts  5 , Asterios Tzalavras  5 , Jakob Hammersen  6 , Frank Kroschinsky  7 , Randolf Forkert  8 , Michael G Kiehl  9 , Michael von Bergwelt-Baildon  10 , Judit Grans-Sibel  1 , Franziska Bach  1 , Jorge Garcia Borrega  1 , Jan-Hendrik Naendrup  1 , Alexander Shimabukuro-Vornhagen  1 , Dennis A Eichenauer #  1 , Boris Böll #  11 ; Intensive Care in Hematologic and Oncologic Patients (iCHOP) working group
Affiliations
Multicenter Study

Targeted antineoplastic therapy in critically ill cancer patients: a multicenter analysis of the iCHOP registry

Anthea Storck et al. Ann Hematol. 2025 May.

Abstract

Approximately 20% of intensive care unit (ICU) patients have cancer, and their prognosis has markedly improved in recent years. In addition to improved treatment in the ICU, this is a result of advancements in cancer therapies, including the use of targeted therapies (TTs), such as antibodies and small-molecule kinase inhibitors. Despite the increasing use of TT, there are currently no comprehensive studies examining critically ill cancer patients receiving TT in the ICU. We studied the clinical characteristics of a multicenter cohort of cancer patients who received TT in the ICU. To this end, we extracted data from the iCHOP Registry, comprising critically ill cancer patients from nine centers in Germany and Austria, and analyzed patient characteristics, cancer therapies, and survival outcomes. We then employed Cox proportional hazards regression and Kaplan‒Meier survival analyses to explore factors associated with mortality. Of the 1,762 cancer patients admitted to the ICU who were analyzed for this study, 106 patients (6%) received TT in the ICU, such as antibody-based treatments, kinase inhibitors and proteasome inhibitors. Although the TT recipients were younger, there were several pronounced high-risk features in the TT cohort, as indicated by a greater proportion of hematologic malignancies and autologous stem cell transplantation (SCT), a greater percentage of progressive disease and fewer patients in complete remission at ICU admission than in patients not receiving TT in the ICU. Despite these more pronounced risk features, TT patients had a slightly longer median OS than did the other patients according to Kaplan‒Meier analysis. The factors associated with mortality according to Cox proportional hazards regression analysis included advanced directives, disease progression, SOFA score, invasive mechanical ventilation (IMV), renal replacement therapy, and duration of ICU and hospital stay. Critically ill cancer patients receiving TT in the ICU had distinct characteristics but had comparable survival outcomes compared to patients receiving any other or no antineoplastic therapy in the ICU. While disease status at ICU admission remains crucial, the present study indicates the feasibility and potential benefits of TT in selected ICU patients.

Keywords: Cancer; Immunotherapy; Intensive care; Targeted therapy; Toxicity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in accordance with the principles of the Declaration of Helsinki and approved by the Institutional Review of the Medical Faculty and the University Hospital Cologne on December 18, 2013 (#13–380). All participating providers from the iCHOP registry obtained institutional review board approval from their institutions in accordance with local ethics regulations. Consent for publication: Not applicable. Competing interests: P.S. has received honoraria from Abbvie, Astro Pharma, Gilead, Jazz Pharmaceuticals, Novartis, Pfizer, and Roche; his University has received research funding from Amgen, Astellas, Astro Pharma, and Baxter; as well as competitive research grants from the Initiative Krebsforschung, the European Society of Intensive Care Medicine, and the European Commission. C.L. has received honoraria from Gilead. A.T. is an advisor for and reports receiving travel support from Kite/Gilead. J.G.B. has received research funding and travel support from Kite/Gilead. D.A.E. has received honoraria from Sanofi-Genzyme and Takeda. B.B. has received honoraria and research funding from Amgen, Gilead, MSD, Miltenyi, Noscendo, Novartis, Pfizer and Takeda. The remaining authors have no financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Targeted treatment agents applied in the ICU
Fig. 2
Fig. 2
Kaplan‒Meier estimate of survival by therapy cohort
Fig. 3
Fig. 3
Standardized hazard ratios of factors associated with mortality after hospital admission in the overall cohort. The error bars represent the 95% confidence intervals. ICU = intensive care unit, SOFA = sequential organ failure assessment
See this image and copyright information in PMC

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