Featuring: Ankit Bharat, MD, MBBS
For the second time at Northwestern Medicine, surgeons have successfully performed a double-lung transplant on a patient with stage 4 lung cancer who was being considered for hospice. The treatment option is now available for select patients with stage 4 lung cancers confined to the lungs in a first-of-its-kind clinical program at Northwestern Medicine called Double Lung Replacement and Multidisciplinary Care (DREAM).
“These are patients diagnosed with some forms of lung cancer that have spread within the lung, are out of treatment options and have limited time to live,” said Ankit Bharat, MD, chief of thoracic surgery and director of Northwestern Medicine Canning Thoracic Institute. “In this unique program we will include select patients with some forms of lung cancer that are limited to the lungs for the consideration of double-lung transplant if conventional or experimental treatments have failed. The purpose of DREAM is to provide the most comprehensive multidisciplinary care for these complex patients.”
“We’re excited to formally launch this unique multidisciplinary program that will include highly experienced specialists across disciplines such as thoracic surgery, pulmonary, and oncology, to help some of the most hopeless patients,” said Rade Tomic, MD, pulmonologist and medical director of the Northwestern Medicine Canning Thoracic Institute Lung Transplant Program.
On September 25, 2021, at the age of 54, Albert Khoury from Chicago, Ill., became the first patient with stage 4 lung cancer to receive a lung transplant at Northwestern Medicine. In early 2020, Khoury was working as a cement finisher when he developed back pain, sneezing, chills, and a cough with mucus. At first, Khoury thought it was COVID-19, but then he was diagnosed with lung cancer and ended up in the intensive care unit on a ventilator when chemotherapy treatments failed. As hospice care was being considered for Khoury, Northwestern Medicine surgeons determined that because his tumor was localized to the chest completely encasing both lungs and hadn’t spread to other parts of his body, he was a candidate for a double-lung transplant. Eighteen months after receiving the lifesaving surgery, Khoury still has no signs of cancer left in his body and has returned to work.
“My life went from zero to 100 because of Northwestern Medicine,” said Khoury. “You didn’t see this smile on my face for over a year, but now I can’t stop smiling. My medical team never gave up on me.”
As Khoury was receiving his transplant in September 2021, Tannaz Ameli of Minneapolis, Minn., was struggling with a lingering cough. By January 2022, the retired nurse went to a large health system in Minnesota where they confirmed she had stage 4 lung cancer. When chemotherapy treatments didn’t help and hospice was recommended, Ameli’s husband reached out to the Northwestern Medicine Canning Thoracic Institute’s Second Opinion Program. Because Ameli’s cancer was confined to the lungs and hadn’t spread to other parts of the body, the 64-year-old was listed for a transplant and received new lungs within 10 days on July 13, 2022.
“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. “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. If you or your loved one has complex conditions such as lung cancer, Northwestern Medicine is the place to be. Everyone is amazing and I can’t thank them enough for saving my life.”
Khoury and Ameli didn’t require any further cancer therapy after transplant.
“Innovation and research have always been a foundational cornerstone at Northwestern Medicine and we’re committed to continually improving the field of transplantation,” said Satish Nadig, MD, PhD, transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center. “Liver transplantation for cancer is commonplace, and while it’s not suitable for all, it’s highly effective in many. Further, transplantation for metastatic cancer to the liver, from the colon, for example, is now past proof-of-concept. It will be exciting to better understand whether we can use transplant principles for certain lung cancer types that have only spread within the lungs.”
Northwestern Medicine surgeons were the first to perform double-lung transplants on COVID-19 patients in the United States, and in the largest single-center series published to date, the post-transplant survival at one year for those patients was above 90%, exceeding national metrics. Using lessons learned from pioneering COVID-19 lung transplantation, Northwestern Medicine surgeons developed a novel surgical technique to clear the cancer during surgery while minimizing the risk of spread that has plagued prior such attempts at other hospitals.
“While lung transplantation is an accepted indication for certain forms of lung cancer by national organizations, it’s infrequently performed due to the concerns of recurrence following surgery. Unlike the conventional technique of sequential transplants, this innovative technique involves putting the patient on full heart and lung bypass, delicately taking both cancer-ridden lungs out at the same time along with the lymph nodes, washing the airways and the chest cavity to clear the cancer, and then putting new lungs in,” said Dr. Bharat. “These patients can have billions of cancer cells in the lungs, so we must be extremely meticulous to not let a single cell spill into the patient’s chest cavity or blood stream. We believe this technique can help reduce the risk of recurrence, which we learned through our experience with pioneering COVID-19 lung transplants.”
“Similar to our experience with COVID-19 lung transplantation, when it comes to donor lung availability, we do not anticipate causing any disadvantage to the non-cancer patients awaiting lung transplant,” said Dr. Tomic. “We plan to mitigate any issues with donor lung availability using our newly launched 'lungs in a box' program, where our surgeons can repair damaged lungs and successfully use them for transplant.”
The outcomes of the program’s first 75 patients will be tracked in a new research registry also called DREAM (Double Lung Transplant Registry Aimed for Lung-limited Malignancies – a prospective observational registry study for patients undergoing lung transplantation for some forms of medically refractory lung cancer confined to the lungs) available on ClinicalTrials.gov. The research registry is focused on the outcomes of the treatment intervention. Participation in the research registry is voluntary. A patient may receive a double-lung transplant as part of the DREAM clinical program, without enrolling in the DREAM research registry.
“Encouraged by our first two patients, the goal of following these registry participants is to maintain close follow-up care by our multidisciplinary team and demonstrate good outcomes while learning new insights about lung cancer,” said Young Chae, MD, medical oncologist at Northwestern Medicine.
This article was originally published in One Live on May 23, 2023.
Ankit Bharat, MD, MBBS , Chief of Thoracic Surgery in the Department of Surgery, Harold L. and Margaret N. Method Professor of Surgery, Professor of Surgery (Thoracic Surgery) and Medicine (Pulmonary and Critical Care)
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