Two people with stage IV lung cancer who had been told that they had only weeks or months to live are breathing freely after receiving double lung transplants, Northwestern Medicine in Chicago said Wednesday.
Lung cancer is the leading cause of cancer-related deaths in the United States. The American Cancer Society estimates that over 127,000 Americans will die from the disease this year.
It is considered stage IV once additional tumors have developed in the lungs, aside from the primary tumor, or the cancer has spread to more organs.
Someone diagnosed with stage IV lung cancer has limited treatment options, Northwestern Medicine says. A double lung transplantation offers a potentially lifesaving option for some people with a poor prognosis, but doctors say there are specific criteria a lung cancer patient must meet, including that the cancer is contained within the lungs and the person has tried all other treatment options.
Time was running out
In 2020, 54-year-old Albert Khoury of Chicago received a devastating lung cancer diagnosis.
Khoury, a cement finisher for the Chicago Department of Transportation, began to have back pain, sneezing and chills, along with coughing up blood, according to Northwestern Medicine. It was near the start of the Covid-19 pandemic, so at first, he thought he had coronavirus-related symptoms.
He was diagnosed with stage I lung cancer soon after.
Because of the pandemic, Khoury did not begin treatment until July 2020. At that point, the cancer had progressed to stage II and was continuing to grow, eventually reaching stage IV. He was told to consider hospice, special care for people near the end of their lives that focuses on comfort and support.
“I had a couple weeks to live,” Khoury said in a video released by the hospital. “Not that much time.”
His sister suggested that he reach out to Northwestern Medicine about the possibility of a double lung transplant.
“I need new lungs. That is the only hope to live,” Khoury said he told his doctor.
He met with an oncologist at Northwestern Medicine, who told him he should try additional treatments first. But not too long after, he was admitted to the intensive care unit with pneumonia and sepsis.
As his health declined, the oncologists began considering the rarely used procedure.
“His lungs were filled with cancer cells, and day by day, his oxygen was dropping,” said Dr. Young Chae, a medical oncologist at Northwestern Medicine who helped treat Khoury.
Not without risk
Transplant is typically considered for people with some form of lung cancer that has not spread to other parts of the body and for those who have tried all other treatment options and have limited time to live, according to Dr. Ankit Bharat, chief of thoracic surgery at the Northwestern Medicine Canning Thoracic Institute, who helped treat Khoury.
William Dahut, chief scientific officer at the American Cancer Society, also noted the importance of ensuring that cancer has not spread to other parts of the body before doing a transplant.
“There would need to be as much certainty as possible that the cancer is limited to the lungs, so whatever sort of extensive screening tests should be done … to ensure that there are no cancer cells outside of the lungs,” said Dahut, who was not involved in the care of either Northwestern patient.
The oncologists decided Khoury was eligible for the procedure. In September 2021, he spent about seven hours in surgery.
“Surgeons had to be extremely meticulous to not let trillions of cancer cells from the old lungs spill out into Khoury’s chest cavity or into his blood stream,” Northwestern Medicine noted in a news release.
The surgery is not without risk, Bharat said. In people with late-stage cancers, there is always a chance of it returning after the procedure.
“There is certainly the risk of potentially being in a worse off situation than they were,” he said. “So you go through a big surgery, and then you could very quickly have the cancer come back.”
Another risk is the treatment needed after a transplant, Dahut said.
All lung transplant recipients have to take medications to weaken their immune systems, which helps reduce the possibility of their body rejecting the organ – but also decreases its ability to fight off infection, according to the National Cancer Institute.
“Drugs that actually suppress your immune system put you at risk for infection afterwards but could even potentially put you at risk for second cancers afterwards,” Dahut said.
However, 18 months later, Khoury has not had any complications and is back to work.
His doctor showed him an X-ray of his chest with no signs of cancer. “When I saw that X-ray, I believed him,” Khoury said. “My body is in my hands now.”
‘I had no hope’
The procedure was put to the test again last year, this time in a 64-year-old Minnesota woman.
Tannaz Ameli, a retired nurse from Minneapolis, had a persistent cough for several months. Her doctors did a chest X-ray and diagnosed her with pneumonia.
The illness lingered until she was told she had stage IV lung cancer in January 2022.
“There was no hope for my life at that point. They gave me … three months,” Ameli said in a video released by Northwestern Medicine.
She went through unsuccessful chemotherapy treatments and was told to consider hospice.
“I had no hope. I was ready for my life to end,” she said.
But her husband reached out to Northwestern Medicine about the option of a transplant. The oncologists found that Ameli fit their criteria, and she received a double lung transplant in July.
When she was told the procedure had made her cancer-free, she wondered, ” ‘Am I dreaming, sitting here? Can it happen?’ And it did happen.”
Ameli hasn’t had any complications, and she said the procedure has given her a new perspective on life.
“Every morning when I open my eyes, I just can’t believe it,” Ameli said. “Life has a different meaning now.”
A different approach
Double lung transplants for cancer are rare due to the concern that the cancer may come back, Bharat said.
Historically, the surgery required sequential transplantations, but they are looking to alter the approach to lower the risk of recurrence, he said.
“Typically, what happens in a double lung transplant procedure is, we take one lung out, put the new one in, then take the second lung out and put the second lung in,” he said. “The concern is that when you take one lung out and put a new lung, the other lung is still attached, and they could cross-contaminate. … You could inadvertently have the cancer cells spread into the bloodstream.”
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If cancer cells cross-contaminate or enter the bloodstream, there is a higher risk of cancer coming back.
Bharat and his team took a different approach with Khoury and Ameli: They opened the chest cavity and did a full heart and lung bypass.
“Essentially, what that means is, we don’t let any blood go through the heart and the lungs and bypass all of that,” Bharat said. “That allows us to then stop the blood flow to the lungs, which will prevent any cancer cells from going from the lung into the bloodstream.”
The surgeons gave Khoury and Ameli lung-shaped friendship necklaces Wednesday to mark their success.