lower in ICUs with clinical pharmacists and multidisciplinary teams [6]. Sepsis management Several studies have reported improved survival rates in cancer patients with septic shock. It is noteworthy that such improvements have appeared more pronounced in the most vulnerable populations, such as patients with malignancies [79, 80], although the current management of septic shock in cancer patients is largely derived from interventional studies in which they were under-represented [52, 81]. This may be attributable to early recognition of sepsis and rapid implementation of sepsis bundles. Furthermore, some observational studies have delineated areas of improvement in neutropenic sepsis, including escalation and de-escalation principles for antimicrobial management, source control including catheter removal in the absence of an alternative focus of infection, and the feasibility and safety of surgery in neutropenic patients even if thrombocytopenic [45, 82, 83]. In the absence of prospective interventional studies in critically ill neutropenic patients, indications for adjuvant G-CSF treatment to shorten the duration of neutropenia remain elusive [84]. G-CSF-enhanced deterioration of respiratory status at the time of recovery from neutropenia is a concern in patients with pulmonary involvement [85,86,87]. Importantly, some aggressive malignancies may manifest as sepsis-like syndromes with multiple organ failures. In these situations of hemophagocytic lymphohistiocytosis (HLH) or severe tumor lysis syndromes, emergent chemotherapy treatment is started in patients receiving life-sustaining therapies [58, 88,89,90]. Chemotherapy (for selected ICU patients with newly diagnosed malignancies) Data from cohort studies suggest that providing cancer chemotherapy along with life-sustaining therapies in critically ill patients with cancer-related organ dysfunctions (organ or vessel compression, tissue infiltration, tumor lysis syndrome, etc.) is feasible and associated with a meaningful survival benefit in selected patient. Patients’ preferences, performance status, and associated comorbidities, together with the availability of life-span-expanding treatment, need to be carefully assessed in close cooperation with the attending oncologist or hematologist [91,92,93]. Associated sepsis or need for life support at the time of chemotherapy onset should not be seen as a contraindication to chemotherapy. However, major concerns related to administration of chemotherapy in the ICU lie in the practical management of antineoplastic drugs by teams with little experience. Dedicated protocols, routine prescription by specialists, daily rounds with hematologists and oncologists, and careful identification and securing of the medication circuit, ideally with the help of a clinical pharmacist, are needed to ensure safe delivery of chemotherapy in critically ill patients [6]. Nurse consultants from the hematology/oncology wards who are familiar with administrating chemotherapy may also provide precious help. Common beliefs contradicted by recent findings The landscape of the management of critically ill patients with cancer has changed dramatically over the past 15 years (Table 2). Intensivists’ skills in understanding the pathophysiology of several diseases, awareness of the risk associated with neutropenia, management of urgent complications related to the malignancy, and their ability to start chemotherapy while providing advanced supportive care have all significantly