by A new treatment for some end-stage lung cancers has succeeded in the first two patients to undergo surgery.
Using knowledge gained during the Covid pandemic, surgeons at Northwestern Medicine in Chicago successfully performed double lung transplants on two patients with stage 4 cancer. Both patients are alive and well.
When cancer spreads from one lung to another and doesn’t respond to standard treatments, including radiation and chemotherapy, patients are usually left with no options.
This was the case of Albert Khoury, 55, of Chicago, who was diagnosed with lung cancer in early 2020. Initially, his tumors were concentrated in only one lung. But despite two rounds of chemotherapy, the cancer had spread to the other lung. It was stage 4.
“They told me, ‘Just spend time with your brothers. You have a few months to live,” he said.
But in September 2021, Khoury became the first person with stage 4 lung cancer to receive a double lung transplant. The new treatment has since been given to a second patient whose cancer had also spread to both lungs, a woman called Tannaz Ameli, 65.
The approach was a last resort for both Khoury and Ameli.
“If all options have been exhausted, only then will we consider it,” said Dr. Ankit Bharat, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute.
Lung transplants for cancer patients have historically involved replacing one lung at a time. The technique comes with considerable risks: The remaining cancerous lung can infect the new lung with cancer, and the incisions can cause cancer cells to leak into the bloodstream.
Bharat and his team at Northwestern took a different approach.
By simultaneously removing both cancerous lungs from the body and replacing them with two healthy transplanted lungs, surgeons can greatly reduce the risk of cancer cells infecting the new organs or other parts of the body. While the lungs are outside the body, patients are connected to a heart-lung bypass machine to keep them alive.
The approach does not apply to all patients with stage 4 lung cancer, but only to those in whom the cancer has spread from one lung to the other but has not spread beyond it.
“Before we even enter the operating room, we have already established with a very high level of certainty that there is no cancer outside the lungs,” Bharat said. “If the cancer is already outside the lung, we can’t do these double lung transplants.”
It was during the pandemic that Northwestern surgeons realized they could do this type of surgery. The first double lung transplants in Covid patients were performed in the same hospital.
“We learned that it was possible to carefully remove severely diseased lungs that have tons of bacteria, which most Covid patients had, without spreading them into the bloodstream,” Bharat said. “So that helped us learn about this approach, which I hope will be very useful for cancer patients.”
However, the process does not come without risks.
“Finding the right patient will be the challenge. It’s a big operation, so you need someone who can tolerate both the surgery and the immunosuppressive treatments you need after the transplant,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. It is too intensive to be used to extend a person’s life a little, and carries too great a risk of complications, he added.
Northwestern’s program, called Northwestern Medicine’s Double Lung Replacement and Multidisciplinary Care, or DREAM, plans to follow the first 75 cancer patients who will receive a double lung transplant. They hope that what they learn from these patients in the long run will help other surgery centers be able to perform the procedure.
Bharat said he expects there will be at least some cancer recurrences, but believes that in most cases, the surgery will allow most patients to live cancer-free.
“Even if we could take a few patients and give them a new life, that’s too profound,” he said.
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Reynolds Lewis contributed.
