New double lung transplant technique is successful in two late-stage cancer patients

A new treatment for certain late-stage lung cancers has been successful in the first two patients to have the surgery.

Using knowledge gained during the Covid pandemic, surgeons at Northwestern Medicine in Chicago have successfully performed double lung transplants on two patients with stage 4 cancer. Both patients are alive and well.

When the cancer spreads from one lung to another and does not respond to standard treatments, including radiation and chemotherapy, patients usually 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 just 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 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 undergo 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.

Tannaz Ameli and Albert Khoury were the first patients to receive a double lung transplant to treat their lung cancer.Northwestern Medicine

The approach was the last resort for both Khoury and Ameli.

“We’re not going to consider this until all options have been exhausted,” said Dr. Ankit Bharat, chief of thoracic surgery and director of the Northwestern Medicine Canning Thoracic Institute.

Lung transplants for cancer patients have traditionally involved replacing one lung at a time. The technique carries some pretty big 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 took 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 infecting the new organs or other parts of the body. While the lungs are out of the body, patients are hooked up to a heart-lung machine to keep them alive.

The approach does not apply to all stage 4 lung cancer patients, but only to those whose cancer has spread from one lung to another, but has not spread further.

Dr. Ankit Bharat led both transplant operations.Teresa Crawford / Northwestern Medicine

“Even before we go into the operating room, we have already established with a very high degree 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 the surgeons of the Northwest realized they could perform this kind of surgery. The first double lung transplants in Covid patients were performed in the same hospital.

“We learned that it was possible to gently remove severely diseased lungs with tons of bacteria that most Covid patients had without spreading it into the bloodstream,” Bharat said. “So that helped us learn more about this approach, which I hope will be very helpful for cancer patients.”

However, the procedure is not without risks.

“Finding the right patient becomes the challenge. It’s major surgery, so you need someone who can tolerate both the surgery and the immunosuppressive therapies you’ll need after the transplant,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. It’s too intensive to be used to prolong someone’s life by a little bit, 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 track the first 75 cancer patients to undergo a double lung transplant. They hope that what they learn from these patients in the long run will help other surgery centers perform the procedure as well.

The Northwestern Medicine thoracic surgery team.Northwestern Medicine

Bharat said he expects there will be at least some cancer recurrences, but believes the surgery will allow most patients to live cancer-free in most cases.

“Even if we could take a few patients and give them a new life, that’s pretty drastic,” he said.

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