A novel treatment for certain late-stage lung cancers has been successful in the first two patients who underwent the operation.
Using knowledge learned 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 often have no options.
That was the case for Albert Khoury, 55, of Chicago, who was diagnosed with lung cancer in early 2020. Initially, his tumors were concentrated in a single 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,’” she said.
But in September 2021, Khoury became the first person with stage 4 lung cancer to receive a double lung transplant. Since then, the new treatment has been carried out on a second patient whose cancer had also spread to both lungs, a 65-year-old woman named Tannaz Ameli.
The approach was a last resort for both Khoury and Ameli.
«If all options have been exhausted, only then will we consider this,» said Dr. Ankit Bharat, chief of thoracic surgery and director of the Canning Thoracic Institute of Northwest Medicine.
Historically, lung transplants for cancer patients have involved replacing one lung at a time. The technique carries some pretty significant risks: The remaining cancerous lung can contaminate the new lung with cancer, and the incisions can cause cancer cells to leak into the bloodstream.
Bharat and his team at Northwestern had a different approach.
By removing both cancerous lungs from the body at the same time and replacing them with two healthy transplanted lungs, surgeons can significantly reduce the risk of cancer cells contaminating new organs or other parts of the body. While the lungs are outside the body, patients are connected to a heart-lung 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 not beyond.
«Before even entering the operating room, we have already established with a very high level of certainty that there is no cancer outside of 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. In the same hospital, the first double lung transplants were performed in patients with Covid.
“We learned that it was possible to remove very diseased lungs that had tons of bacteria, which most covid patients had, carefully without spreading it into the bloodstream,” Bharat said. «That helped us learn about this approach, which I hope will be very useful for cancer patients.»
Still, the procedure is not without risk.
“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 therapies you need after transplant,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. It’s too intensive to be used to extend a person’s life just a little, and it 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 term will help other surgery centers to be able to perform the procedure as well.
Bharat said he anticipates there will be at least some cancer recurrences, but believes that in most cases, the operation will allow the majority of patients to live cancer-free.
«Even if we could take some patients and give them a new life, that’s pretty profound,» he said.
reynolds lewis contributed.