Some specific treatments for end-stage lung cancer have shown success in the first two patients to be operated on.
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 the patients are alive and doing well.
When cancer has spread from one lung to another, and does not respond to standard treatments including radiation and chemotherapy, patients usually have no options left.
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. This 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 receive a double lung transplant. The novel treatment has since been used on a second patient whose cancer had also spread to both lungs, a 65-year-old woman named Tanaj Amelie.
This was the last resort for both Khoury and Amelie.
“We’re only going to consider this if all options have been exhausted,” said Dr. Ankit Bharat, chief of thoracic surgery and director of Northwestern Medicine’s Canning Thoracic Institute.
Lung transplants for cancer patients have historically involved replacing one lung at a time. The technique comes with some hefty risks: The remaining cancerous lung can contaminate the new lung with cancer, and cancer cells can leak into the bloodstream from the incisions.
Bharath and his team at Northwestern had a different approach.
By taking both cancerous lungs out of the body at the same time and replacing them with two healthy transplanted lungs, surgeons can greatly 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 bypass machine to keep them alive.
This approach does not apply to all stage 4 lung cancer patients, but only to those in whom cancer has spread from one lung to the other but not beyond.
“Before we even enter the operating room, we have already established with a very high degree of certainty that there is no cancer outside the lungs,” Bharath 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 perform this type of surgery. The first double lung transplant in Covid patients was done in this hospital.
“We found that it was possible to take out the very diseased lungs, which contain tons of bacteria, that most Covid patients had, carefully without spreading it into the bloodstream,” Bharath said. “So that helped us learn about this approach, which I hope will be of great help to cancer patients.”
Still, the procedure doesn’t come without risk.
“Finding the right patient will be the challenge. It’s a major operation, so you need someone who can tolerate both the surgery and the immunosuppressive treatment you’ll need after the transplant,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. he said. It’s too intense to be used to extend a person’s life even a little bit, and it carries a huge risk of complications, he said.
Northwestern’s program, called Northwestern Medicine’s Double Lung Replacement and Multidisciplinary Care, or DREAM, plans to track the first 75 cancer patients to receive a double-lung transplant. He hopes that in the long run what he learns from these patients will help other surgery centers perfect the procedure.
Bharath said he anticipates there will be at least some recurrence of the cancer, but believes that in most cases, the operation will allow most patients to remain cancer-free.
“Even if we can take some patients and give them a new life, it is profound,” he said.
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