Acute respiratory failure is the primary reason for intensive care unit admission among cancer patients and is associated with high mortality, especially in those requiring invasive mechanical ventilation. Compared with non-oncologic patients, these individuals often have longer ICU and hospital stays and worse outcomes. Nonconventional ventilation modes have been developed to overcome the limitations of standard mechanical ventilation, but oncology-specific evidence remains scarce. Open-loop systems such as airway pressure release ventilation (APRV) and time-controlled adaptive ventilation (TCAV) offer physiological and synchrony advantages in selected contexts. Close-loop systems, proportional assist ventilation (PAV), and adaptive support ventilation (ASV) adapt their output based on the patient and system’s feedback. Extracorporeal membrane oxygenation (ECMO) may be considered in refractory cases after careful selection. We review these ventilatory modes considering their principles, benefits, and contraindications, highlighting the need for individualized strategies and further research to inform evidence-based guidelines for this high-risk population.