When traditional treatments such as chemotherapy and radiation fail, lung cancer can be a death sentence for many patients.
That, however, may be changing, with Northwestern Medicine leading the way.
Northwestern plans to begin regularly performing double lung transplants on patients with terminal lung cancer, after successfully transplanting lungs into two patients who would have otherwise died of the disease, the health system announced Wednesday.
Northwestern surgeons successfully performed a double lung transplant on Albert Khoury, then 54 of Chicago, in 2021, after he was diagnosed with stage 4 lung cancer. Northwestern then performed a second similar transplant on Tannaz Ameli, 64, of Minneapolis, last July. Moving forward, Northwestern hopes to do at least 10 to 15 such transplants a year. The outcomes of the first 75 patients to participate will be tracked in a new research registry available on ClinicalTrials.gov.
“We are really excited about this because these are patients that are some of the most hopeless patients because a lot of them are going to be at the end of the road, and to be able to make such a dramatic impact, it’s quite compelling,” said Dr. Ankit Bharat, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute.
Until now, lung transplants on patients with advanced lung cancer have been rare operations. Typically, patients with cancer are not eligible to receive organ transplants because it’s feared that the cancer will recur after the transplant. Patients who receive new organs must take medication to suppress their immune systems, which can lead to a recurrence if any cancer cells are left in the body.
Northwestern doctors, however, used lessons learned during the COVID-19 pandemic to perform the transplants on cancer patients. In June 2020, Northwestern performed the first known double lung transplant in the country for a COVID-19 patient whose lungs were severely damaged by the disease. During that and subsequent similar surgeries, doctors had to be careful not to contaminate the blood stream during the transplant.
“Most COVID transplants we did had tons of bacteria in them,” Bharat said. “We felt if we could carefully remove those lungs and transplant them, we probably should be able to do the same in cancer ridden lungs.”
In the lung cancer transplant surgeries, patients are put on full heart and lung bypass, while both lungs are removed at the same time, along with the lymph nodes. Doctors wash the airways and the chest cavity to clear the cancer before putting in the new lungs, he said.
Not all patients with lung cancer are eligible for the surgery. The surgery is only for patients whose cancer has not spread beyond their lungs and who have run out of other treatment options, such as chemotherapy, radiation, immunotherapy and other surgeries.
The two patients who’ve already received the transplants at Northwestern are still cancer free, Bharat said.
Khoury underwent the 7-hour-long surgery in September 2021. Khoury, who was a nonsmoker, said he was told by doctors at other health systems that he wouldn’t survive. Before the transplant at Northwestern, he was on a ventilator and had developed pneumonia and sepsis. When he got a transplant, he likely only had days left to live, said Dr. Young Chae, a medical oncologist with Lurie Cancer Center at Northwestern Medicine.
Meanwhile, Ameli was diagnosed with stage 4 lung cancer in January 2022. She underwent chemotherapy, without success, and was recommended for hospice. Her husband reached out to the Northwestern Medicine Canning Thoracic Institute’s Second Opinion Program, where she was told she was eligible for a transplant.
“I begged my doctors in Minnesota to consider a lung transplant, but they wouldn’t do it. Luckily, my husband refused to give up and pushed for a second opinion,” said Ameli, a retired nurse and grandmother of four, in a news release. “When I came to Northwestern Medicine, the first thing Dr. Bharat told me was, ‘I think we can make you cancer-free,’ and he delivered on those words.”
Northwestern is now working with other health systems across the country, in hopes that other hospitals will develop similar programs, giving more patients the option of a transplant, Bharat said.
