New double lung transplant technique succeeds in two patients with advanced cancer
A new treatment for some advanced lung cancers has successfully operated on the first two patients.
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 safe and sound.
When cancer spreads from one lung to another and does not respond to standard treatments, including radiation therapy and chemotherapy, patients usually have no options.
Such was the case of 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 cycles of chemotherapy, the cancer had spread to the other lung. It was stage 4.
“They said to me, ‘Just hang out with your siblings. 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 performed on a second patient whose cancer had also spread to both lungs, a woman named Tannaz Ameli, 65.
The approach was the last resort for Khoury and Ameli.
“If all options have been exhausted, only then are we going to consider this,” said Dr. Ankit Bharat, chief of thoracic surgery and director of the Northwestern Medicine Canning Thoracic Institute.
Lung transplants for cancer patients have always 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 cancerous cells contaminating new organs or other parts of the body. While the lungs are out of the body, patients are hooked up to a heart-lung bypass machine to keep them alive.
The approach does not apply to all patients with stage 4 lung cancer, only those in whom the cancer has spread from one lung to the other but has not spread 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 surgeons in the North West realized they could perform 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 remove critically ill lungs that contain tons of bacteria, which most Covid patients had, with care without spreading it into the bloodstream,” Bharat said. “So it helped us learn more about this approach, which I hope will be very useful for cancer patients.”
Still, the procedure 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 therapies you need post-transplant,” said Dr. William Dahut, chief scientific officer of American Cancer Society. It’s too intensive to be used to extend a person’s life a bit, 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 to receive a double lung transplant. They hope what they learn from these long-term patients will help other surgery centers be able to perform the procedure as well.
Bharat said he expects there will be at least some recurrence of cancers, but believes that in most cases the operation will allow most patients to live cancer-free.
“Even if we could take a few patients and give them new life, that’s pretty profound,” he said.
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Reynolds Lewis contributed.