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CNN
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Two people with stage IV lung cancer who had been told they had weeks or months to live are breathing freely after receiving double lung transplants, Chicago-based Northwestern Medicine 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 when other tumors have developed in the lungs in addition to the primary tumor or the cancer has spread to other organs.
According to Northwestern Medicine, someone diagnosed with stage IV lung cancer has limited treatment options. A double lung transplant offers a potentially life-saving option for some people with a poor prognosis, but doctors say a lung cancer patient must meet certain criteria, including that the cancer in the lungs is contained and the person has tried all other treatment options.
In 2020, 54-year-old Chicago native Albert Khoury was diagnosed with lung cancer.
Khoury, a cement paver for the Chicago Department of Transportation, developed back pain, sneezing and chills, and coughing up blood, according to Northwestern Medicine. It was just before the start of the Covid-19 pandemic, so at first he thought he had symptoms related to the coronavirus.
Shortly thereafter, he was diagnosed with stage I lung cancer.
Due to the pandemic, Khoury did not start treatment until July 2020. By that time 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 at the end of their lives that focuses on comfort and support.
“I had a few weeks to live,” Khoury said in a video released by the hospital. “Not so much time.”
His sister suggested he contact Northwestern Medicine about the possibility of a double lung transplant.
“I need new lungs. It’s the only hope for life,” Khoury told his doctor.
He met with an oncologist from Northwestern Medicine, who told him to try additional treatments first. But not too long after that, he was admitted to the ICU with pneumonia and sepsis.
As his health deteriorated, oncologists began considering the rarely used procedure.
“His lungs were filled with cancer cells and his oxygen was dropping day by day,” said Dr. Young Chae, a medical oncologist at Northwestern Medicine who helped treat Khoury.
according to dr Ankit Bharat, chief of thoracic surgery, typically considers a transplant for people with a form of lung cancer that hasn’t spread to other parts of the body and for those who have tried all other treatment options and only have a limited time to live have at Northwestern Medicine Canning Thoracic Institute who helped treat Khoury.
William Dahut, scientific director of the American Cancer Society, also noted the importance of making sure the cancer hadn’t spread to other parts of the body before a transplant.
“There would need to be as much certainty as possible that the cancer is confined to the lungs, so extensive screening tests should be done … to make sure there are no cancer cells outside of the lungs,” said Dahut, who wasn’t on duty one of the northwestern patients involved.
The oncologists decided that Khoury was a candidate for the procedure. In September 2021 he spent around seven hours in the operating room.
“Surgeons had to be extremely careful to prevent trillions of cancer cells from the old lung from entering Khoury’s chest cavity or bloodstream,” Northwestern Medicine said in a press release.
The operation is not without risk, Bharat said. In people with late-stage cancer, there is always a chance that it will return after the procedure.
“There’s certainly a risk of potentially being in a worse situation than they were,” he said. “So you’re going through major surgery, and then the cancer could come back very quickly.”
Another risk is the treatment required after a transplant, Dahut said.
All lung transplant recipients must take medication to weaken their immune system, which helps reduce the chance their body will reject the organ — but also reduces its ability to fight off infection, according to the National Cancer Institute.
“Drugs that actually suppress your immune system put you at risk of infection afterwards, but could potentially even put you at a second risk of cancer afterwards,” Dahut said.
However, 18 months later, Khoury has had no complications and is back to work.
His doctor showed him an X-ray of his chest with no evidence of cancer. “When I saw the X-ray, I believed him.” said Khoury. “My body is in my hands now.”
The process was put to the test again last year, this time in a 64-year-old woman from Minnesota.
Tannaz Ameli, a retired Minneapolis nurse, had a persistent cough for several months. Her doctors took a chest X-ray and diagnosed pneumonia.
The illness lasted until she was told in January 2022 that she had stage IV lung cancer.
“At that point there was no hope for my life. They gave me… three months,” Ameli said in a video released by Northwestern Medicine.
She went through unsuccessful chemotherapy treatments and was urged to consider hospice care.
“I had no hope. I was ready for the end of my life,” she said.
But her husband approached Northwestern Medicine about the possibility of a transplant. Oncologists determined that Ameli met 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 as I sit here? Can that happen?’ And it happened.”
Ameli had no complications, and she said the procedure gave 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.”
Double lung transplants for cancer are rare amid fears the cancer may come back, Bharat said.
In the past, the surgery required back-to-back transplants, but they’re trying to change the approach to lower the risk of a recurrence, he said.
“Usually what happens in a double lung transplant is that we take out one lung, put in the new one, then take out the second lung and put in the second lung,” he said. “The concern is that if you take out one lung and put in a new lung, the other lung is still attached and they could contaminate each other. … You could inadvertently allow the cancer cells to spread into the bloodstream.”
If cancer cells cross-contaminate or enter the bloodstream, there is a higher risk of the cancer coming back.
Bharat and his team took a different approach to Khoury and Ameli: they opened the chest cavity and performed a complete heart and lung bypass.
“Essentially, that means we don’t allow blood to flow through the heart and lungs and bypass all of that,” Bharat said. “We can then use this to stop blood flow to the lungs, which prevents cancer cells from moving from the lungs into the bloodstream.”
Surgeons gave Khoury and Ameli lung-shaped friendship necklaces on Wednesday to mark their success.
