For the first time at Northwestern Medicine, surgeons have successfully performed a double-lung transplant on a patient who had the one lung damaged from lung cancer and the other damaged by COVID-19. The patient, 56-year-old Arthur “Art” Gillespie of Chicago, has worked in law enforcement for nearly 30 years, most recently as a captain with the University of Chicago Police Department. When doctors at other health systems told Gillespie there was nothing more they could do for him, he turned to the 

Northwestern Medicine Canning Thoracic Institute

, where surgeons pioneered lung transplantation for 

 in the United States and using those same lessons, developed lung transplantation for select patients with 

 through a first-of-its-kind clinical program called the 

Double Lung Replacement and Multidisciplinary Care (DREAM) Program

“Arthur was in a unique situation because he got a severe case of COVID in March 2020 right around the same time he was diagnosed with lung cancer,” said 

, chief of thoracic surgery and director of the Canning Thoracic Institute who performed Gillespie’s transplant. “When Arthur first came to see us in September 2023, even though he looked physically strong, he could barely speak a single sentence without getting short of breath or take a few steps before having to sit down. The pressure inside the lungs had also increased to a point that it was causing heart failure, and his only option for survival was a double-lung transplant.”

“Four years after the start of the pandemic, COVID still has an impact on patients, but in a different way,” said 

, pulmonologist and medical director of the 

. “While lung transplants for acute damage from COVID is quite rare these days, we’re now starting to see patients who may have had moderate to severe cases of COVID coming in with signs of lung fibrosis. The scarring of the lungs gets more heightened in patients who recovered from COVID but get another respiratory infection like COVID, RSV or influenza because it compounds the original damage that COVID caused.”

When the pandemic started, Gillespie never imagined it would lead to him needing a double-lung transplant, or the impact the virus would have on his family.

“I lost my dad, uncle and cousin to COVID,” said Gillespie. “In February 2020, my dad and I went to visit my uncle in a nursing facility and by early March, we were all sick. I was hospitalized for 12 days with a high fever and cough, and during that time, they were taking scans of my lungs, which showed stage 1 lung cancer on my right lung. I had no symptoms of lung cancer, so in a way – because of COVID – we were able to catch the cancer early.”

After being discharged from the hospital, Gillespie started chemotherapy treatments and underwent surgery at another health system in November 2020 to have two-thirds of his right lung removed. His intent was to get better and return to work, but that never happened. For the next three years, Gillespie continued physical therapy treatments and worked out at his home gym, but his body was getting weaker, and he needed supplemental oxygen daily. 

“Despite my best efforts, I could feel myself going backwards. My right remaining lung was damaged from lung cancer, and my left lung was damaged from COVID. My circumstances were exactly what the Canning Thoracic Institute was built for, and I knew I needed to seek a second opinion,” said Gillespie.

In September 2023, Gillespie had his first consultation at Northwestern Medicine, and by November he was listed for a double-lung transplant. On January 6, Gillespie received his new lungs at Northwestern Memorial Hospital and continues getting stronger every day. May 12-18 marks National Police Week, and while Gillespie still isn’t sure if or when he can return to work as a police captain, he hopes his story resonates with fellow officers to prioritize their health.

“My recovery from the double-lung transplant has been easier than my recovery from lung cancer surgery,” said Gillespie. “I want my story to serve as a lesson to others – especially those in law enforcement. When you’re a public servant, it’s easy to become distracted with the routine of the job. You’re used to putting others before your own health, but we have to be equally proactive and seek a second opinion when we know something isn’t right. A second opinion saved my life and I’m overwhelmed with gratitude for Northwestern Medicine. The lung transplant team listened to my concerns, didn’t dismiss them, and gave me a sense of direction.”

“Arthur is a fighter. He had two major problems – lung cancer and COVID. Historically, both would be considered non-salvageable for lung transplantation, but we were able to treat both of those conditions with a double-lung transplant procedure,” said Dr. Bharat. “Despite being told ‘no’ by other doctors, Arthur had the courage and determination to keep searching for answers. I feel honored that we were able to help him since he spent so many years helping the community as a police captain.”

To date, the Canning Thoracic Institute has performed more than 45 lung transplants for COVID-19 patients, and more than 40 lung transplants for lung cancer patients. The Institute is currently the only clinical site in the nation offering this treatment for lung cancer patients without any other options.

Cancers of the lung are the leading cause of cancer-related deaths in the United States in both men and women with more people dying of lung cancer than colon, breast and prostate cancers combined. Patients interested in being evaluated for a lung transplant can contact the 

 at 844.639.5864. For more information about Northwestern Medicine’s transplant programs, as well as advanced therapies, visit 

Articles

Seeking a second opinion, Arthur “Art” Gillespie turned to Northwestern Medicine for a life-saving double-lung transplant procedure.

When Lung Cancer Took One Lung and COVID Took the Other, a Chicago Police Captain Was Left With Only One Option for Survival

In the aftermath of Alabama Supreme Court’s in vitro fertilization ruling, the state’s reproductive-age women with cancer, who face a high likelihood of future infertility, “are losing the standard-of-care option to build a family following their necessary medical treatments,” said Northwestern Medicine fertility preservation expert Dr. Kara Goldman.

“Reproductive-age patients with cancer have few effective options to preserve their future fertility, and it is unfathomable to take one such option away from this already vulnerable population,” said Goldman, an associate professor of reproductive endocrinology and infertility at Northwestern University Feinberg School of Medicine and director of fertility preservation at Northwestern Medicine. “A profound consequence of this ruling — a ruling based merely on religious belief and without scientific merit —is an unacceptably high risk of infertility for patients with cancer and other fertility-threatening conditions.”

Dr. Goldman is available for interviews with the media. Contact Kristin Samuelson at 

Traveling across state lines for care is ‘unacceptable’

“Reproductive-aged people with cancer should be adequately counseled about the impacts of their treatment on fertility and offered fertility preservation as part of comprehensive cancer care, according to the American Society of Clinical Oncology and the American Society for Reproductive Medicine,” Goldman said. “For those suggesting that patients can merely travel across state lines to access fertility preservation care, or that patients can consider alternative methods of fertility preservation, these substitutes are both logistically and medically unacceptable.

A consequence of the Alabama Supreme Court’s in vitro fertilization ruling is an unacceptably high risk of infertility for patients with cancer.



Patients With Cancer in Alabama 'Being Robbed of the Choice to Build a Family After Treatment'

Women diagnosed with ovarian cancer may initially respond well to chemotherapy, but the majority of them will develop resistance to treatment and die from the disease.

Now Northwestern Medicine scientists have discovered the Achilles heel of chemotherapy-resistant ovarian cancer—its hunger for cholesterol—and how to sneakily use that to destroy it.

In a new study, scientists first showed that chemotherapy-resistant ovarian cancer cells and tumors are rich in cholesterol due to an increased uptake of it. They then deployed a synthetic nanoparticle that appeared to the cancer cells as a natural one rich in cholesterol. But when the cancer cells bound the fake particle, the mimic actually blocked cholesterol uptake. Additionally, the scientists showed that reducing cholesterol tricked the cancer cells down a cell death pathway. Treatment with the nanoparticle reduced ovarian tumor growth by more than 50% in human cells and animal models.

“This is a new weapon to destroy resistant ovarian cancer,” said co-corresponding author C. Shad Thaxton, associate professor of urology at Northwestern University Feinberg School of Medicine.

“More than 18,000 women die of ovarian cancer every year,” said co-corresponding author Dr Daniela Matei, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine oncologist. “Finding new ways to attack resistant cancer cells is very important.”

Matei and Thaxton show the way the cells die after treatment with these nanoparticles is a form of cell death executed through oxidation of lipids in the cell membrane.

“These cancer cells are resistant to the typical form of death — apoptosis — which is why chemo can’t kill them,” Matei said.

Thaxton and Dr Leo Gordon’s earlier pre-clinical research using nanoparticles to treat lymphoma

, showed the approach also works in ovarian cancer cells.

Matei and Thaxton tested the nanoparticles in animal models. The next step in the research is to test a combination of the particles with traditional chemotherapy and study the effects of the nanoparticles on immune cells that fight against cancer.

Matei also is the Diana Princess of Wales Professor of Cancer Research. She and Thaxton are both members of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Other Northwestern authors are Yinu Wang; Andrea E. Calvert; Horacio Cardenas; Jonathon S. Rink; Dominik Nahotko; Wenan Qiang; C. Estelle Ndukwe; Fukai Chen; Russell Keathley; Yaqi Zhang; and Ji-Xin Cheng.

The title of the article is “Nanoparticle Targeting in Chemo-Resistant Ovarian Cancer Reveals Dual Axis of Therapeutic Vulnerability Involving Cholesterol Uptake and Cell Redox Balance.”

The research was funded by a grant from the U.S. Department of Defense Office of the Assistant Secretary of Defense for Health Affairs, through the Ovarian Cancer Research Program.

****Thaxton and Andrea Calvert have a relationship with Zylem Biosciences, Inc., which is a start-up biotechnology company with license to the drug technology from Northwestern University.

Northwestern Medicine scientists have discovered the Achilles heel of chemotherapy-resistant ovarian cancer—its hunger for cholesterol.

Outsmarting Chemo-Resistant Ovarian Cancer

Scientists at the UC San Francisco (UCSF) and Northwestern Medicine may have found a way around the limitations of engineered T cells by borrowing a few tricks from cancer itself.

studying mutations in malignant T cells that cause lymphoma

, they zeroed in on one that imparted exceptional potency to engineered T cells. Inserting a gene encoding this unique mutation into normal human T cells made them more than 100 times more potent at killing cancer cells without any signs of becoming toxic.

While current immunotherapies work only against cancers of the blood and bone marrow, the T cells engineered by Northwestern and UCSF were able to kill tumors derived from skin, lung and stomach in mice. The team has already begun working toward testing this new approach in people.

“We used nature’s roadmap to make better T cell therapies,” said Dr. Jaehyuk Choi, an associate professor of dermatology and of biochemistry and molecular genetics at Northwestern University Feinberg School of Medicine. “The superpower that makes cancer cells so strong can be transferred into T cell therapies to make them powerful enough to eliminate what were once incurable cancers.”

“Mutations underlying the resilience and adaptability of cancer cells can super-charge T cells to survive and thrive in the harsh conditions that tumors create,” said Kole Roybal, associate professor of microbiology and immunology at UCSF, center director for the Parker Institute for Cancer Immunotherapy Center at UCSF, and a member of the Gladstone Institute of Genomic Immunology.

Creating effective immunotherapies has proven difficult against most cancers because the tumor creates an environment focused on sustaining itself, redirecting resources like oxygen and nutrients for its own benefit. Often, tumors hijack the body’s immune system, causing it to defend the cancer, instead of attacking it.

Not only does this impair the ability of regular T cells to target cancer cells, it undermines the effectiveness of the engineered T cells that are used in immunotherapies, which quickly tire against the tumor’s defenses.

“For cell-based treatments to work under these conditions,” Roybal said, “we need to give healthy T cells abilities that are beyond what they can naturally achieve.”

The Northwestern and UCSF teams screened 71 mutations found in patients with T cell lymphoma and identified which ones could enhance engineered T cell therapies in mouse tumor models. Eventually, they isolated one that proved both potent and non-toxic, subjecting it to a rigorous set of safety tests.

“Our discoveries empower T cells to kill multiple cancer types,” said Choi, a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “This approach performs better than anything we’ve seen before.” Their discoveries can be incorporated into treatments for many types of cancer, the scientists said.

“T cells have the potential to offer cures to people who are heavily pretreated and have a poor prognosis,” Choi said. “Cell therapies are living drugs, because they live and grow inside the patient and can provide long-term immunity against cancer.”

In collaboration with the Parker Institute for Cancer Immunotherapy and Venrock, Roybal and Choi are building a new company, Moonlight Bio, to realize the potential of their groundbreaking approach. They are currently developing a cancer therapy that they hope to begin testing in people within the next few years.

“We see this as the starting point,” Roybal said. “There’s so much to learn from nature about how we can enhance these cells and tailor them to different types of diseases.”

Choi has affiliations with and financial interests in Moonlight Bio. Northwestern University has financial interests (equity, royalties) in Moonlight Bio.

New technique made human T cells 100 times more potent at killing cancer cells.

Using Cancer’s Strength to Fight Against It

Receiving a diagnosis of asthma, lung cancer or respiratory failure can be scary and challenging. Receiving care from a medical team that doesn’t speak your preferred language can make the experience more difficult. 

The Northwestern Medicine Canning Thoracic Institute Hispanic Program

 was recently launched to offer personalized care for lung and thoracic patients in their native language, making life-saving care more accessible for the Hispanic community and people who prefer to speak Spanish by removing cultural and linguistic barriers.

“Chicago and its surrounding areas are composed of a diverse population that continues to grow, but there isn’t a structured clinical program providing cutting-edge care for patients with lung or thoracic diseases in Spanish. People from different cultures may have specific needs for communicating with their physicians, and we’re honored to bring that personalized care to patients in their native language,” said 

, a thoracic surgeon who grew up in Colombia and now leads the Northwestern Medicine Canning Thoracic Institute (CTI) Hispanic Program. “Speaking the same language provides a human touch, and we believe the CTI Hispanic Program will encourage patients to seek health care sooner, complete their recommended treatments, and experience better outcomes.”

In January, 45-year-old Nanci Alao of Chicago, Ill., was diagnosed with stage 1 lung cancer and underwent surgery with Dr. Avella to have the cancer removed. The surgery was successful, and Alao went home the next day cancer-free. She’s now back at work and no longer experiences pain and shortness of breath. Alao says, even though she understands English, Spanish is her primary language, and being able to communicate in Spanish with her medical team made the process seamless.

“My care was excellent primarily because it was in Spanish,” said Alao. “Even though there are wonderful interpreters available at Northwestern Medicine, it’s different from being able to speak with a doctor in your same language. Dr. Avella explained the type of cancer I had and why follow up appointments are needed. If anything concerning appears down the road, I trust we’ll be able to detect it early. Having everything in Spanish was the best, and I felt like I was at home.”

Every team member with the CTI Hispanic Program speaks Spanish, and they have a dedicated phone line for patients who prefer to communicate in Spanish. The team includes a thoracic surgeon, pulmonologist, patient procedure schedulers, front desk staff, social workers, clinic nurses and operating room nurses.

“As the son of Mexican immigrants growing up on the southside of Chicago, I can personally relate to having the hardship of communicating with your doctor to truly comprehend issues with your health,” said 

, pulmonologist with the CTI Hispanic Program. “Our goal is to make patients feel comfortable talking with their medical team about everything from diagnosis to treatment, what they can expect shortly after surgery, and in the long-term. We want to provide this personalized care for as many patients as possible in the Chicagoland area.”

Thoracic services at the CTI Hispanic Program include surgical treatment for lung cancer, esophageal cancer, gastroesophageal reflux disease (GERD), lung transplantation and more. Pulmonary services include treatment for asthma, emphysema, long-term pulmonary disease, other respiratory illnesses and more. To view the full list of services and treatments, 

For more information or to schedule an appointment, call 847.738.4863.

The Northwestern Medicine Canning Thoracic Institute Hispanic Program was recently launched to offer personalized care for lung and thoracic patients in their native language, making life-saving care more accessible for the Hispanic community and people who prefer to speak Spanish by removing cultural and linguistic barriers.

Northwestern Medicine Launches a Hispanic Program for Patients With Lung and Thoracic Diseases

A research team led by Northwestern University and the University of Pennsylvania scientists has created a new synthetic biology approach, a “QR code for cancer cells,” to follow tumor cells over time, finding there are meaningful differences in why a cancer cell dies or survives in response to anti-cancer therapies, findings published today in 

Remarkably, what fate cancer cells choose after months of therapy is “entirely predictable” based on seemingly small, yet important, differences that appear even before treatment begins. The investigators also discovered the reason is not genetics, contrary to beliefs held in the field.

The study outlined the team’s new technology platform that developed a “QR code” for each of the millions of cells for scientists to find and use later — much like tagging swans in a pond. The QR code directs investigators to a genome-wide molecular makeup of these cells and provides information about how they’ve reacted to cancer treatment.

“There are many ways cells become different from each other,” said Yogesh Goyal, PhD, assistant professor of Cell and Developmental Biology, and the paper’s lead and co-senior author. “Our lab asks, ‘How do individual cells make decisions?’ Understanding this in the context of cancer is all the more exciting because there’s a clinically relevant dichotomy: A cell dies or becomes resistant when faced with therapies.”

Goyal also has courtesy appointments in chemical and biological engineering and biomedical engineering at the McCormick School of Engineering. He is a member of Northwestern’s Center for Synthetic Biology and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Goyal shares the senior author title with Arjun Raj, PhD, a geneticist at the University of Pennsylvania.

In the study, the lab and collaborators sought to apply synthetic biology tools to answer a key question in cancer research: What makes certain tumors come back a few months or years after therapy? In other words, could the lab understand what causes some rare cells to develop therapeutic resistance to a drug?

Some scientists in the field think genetic differences in the DNA of rare cells are what drive drug resistance. Co-author Nico Bodkin, a student in the Medical Scientist Training Program (MSTP) and quantitative scientist in the Goyal lab, disagreed.

“I wanted to demonstrate there isn’t a genetic mutation that’s causing this resistance because the populations of cells we looked at were expected to be genetically indistinguishable,” Bodkin said.

To investigate this hypothesis, the team put the before-and-after cloned cells through a whole genome sequencing pipeline to compare the populations and found no systematic underlying genetic mutations.

Using the interdisciplinary team — as well as his own training as an engineer with a strong mathematics background — Goyal helped develop the “QR code” framework, FateMap, that could identify each unique cell that seemed to develop resistance to drug therapy. “Fate” refers to whether a cell dies or survives (and if so, how), and the scientists “map” the cells across their lifespan, prior to and following anti-cancer therapy. FateMap is the result of work from several research institutions, and it applies an amalgamation of concepts spanning several disciplines, including synthetic biology, genome engineering, bioinformatics, machine learning and thermodynamics.

“Some are different by chance — just as not all leaves on a tree look the same — but we wanted to determine if that matters,” Goyal said. “The cell biology field has a hard time defining if differences have meaning.”

By gathering data from before-and-after treatment, the scientists found that what cells do is completely determined prior to drug exposure. Finding differences in cells before adding a drug could therefore lead to the development of new therapies that target the driver of differences, rather than the result of it.

Goyal said their next set of questions lies in whether cell behavior can be predicted across multiple different cell therapies and cancer types. Do the same cells become resistant to treatment in other models or is a different set of cells impacted?

“This is just the beginning,” Goyal said. “I expect the conceptual and technological advances from our work to be readily generalizable to disparate biological problems, from cancer to embryo development to regenerative medicine. Our work emphasizes the need to use approaches that seamlessly tread disciplinary boundaries to develop lasting treatments for cancer and beyond.”

The study was funded by the National Institutes of Health, the National Science Foundation, the Burroughs Welcome Fund, the Cancer Research Foundation, the Jane Coffin Childs Memorial Fund, the Schmidt Science Fellowship and the Miriam and Sheldon G. Adelson Medical Research Foundation.

Scientists develop ‘QR code for cancer cells,’ like tagging swans in a pond.

Scientists Uncover Why Some Cells Become Resistant to Cancer Therapies

A major impediment to treating the deadly brain cancer glioblastoma has been that the most potent chemotherapy can’t permeate the blood-brain barrier to reach the aggressive brain tumor.

But now Northwestern Medicine scientists report results of the first in-human clinical trial in which they used a novel, skull-implantable ultrasound device to open the blood-brain barrier and repeatedly permeate large, critical regions of the human brain to deliver chemotherapy that was injected intravenously.

The four-minute procedure to open the blood-brain barrier is performed with the patient awake, and patients go home after a few hours. The results show the treatment is safe and well tolerated, with some patients getting up to six cycles of treatment.

This is the first study to successfully quantify the effect of ultrasound-based blood-brain barrier opening on the concentrations of chemotherapy in the human brain. Opening the blood-brain barrier led to an approximately four- to six-fold increase in drug concentrations in the human brain, the results showed.

Scientists observed this increase with two different powerful chemotherapy drugs, paclitaxel and carboplatin. The drugs are not used to treat these patients because they do not cross blood-brain barrier in normal circumstances.

In addition, this is the first study to describe how quickly the blood-brain barrier closes after sonication. Most of the blood-brain barrier restoration happens in the first 30 to 60 minutes after sonication, the scientists discovered. The findings will allow optimization of the sequence of drug delivery and ultrasound activation to maximize the drug penetration into the human brain, the authors said.

“This is potentially a huge advance for glioblastoma patients,” said lead investigator Adam Sonabend, MD, an associate professor of neurological surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurosurgeon.

Temozolomide, the current chemotherapy used for glioblastoma, does cross the blood-brain barrier, but is a weak drug, Sonabend said.

The paper was published May 2 in The Lancet Oncology.

The blood-brain barrier is a microscopic structure that shields the brain from the vast majority of circulating drugs. As a result, the repertoire of drugs that can be used to treat brain diseases is very limited. Patients with brain cancer cannot be treated with most drugs that are otherwise effective for cancer elsewhere in the body, as these do not cross the blood-brain barrier. Effective repurposing of drugs to treat brain pathology and cancer require their delivery to the brain.

In the past, studies that injected paclitaxel directly into the brain of patients with these tumors observed promising signs of efficacy, but the direct injection was associated with toxicity such as brain irritation and meningitis, Sonabend said.

Blood-brain barrier recloses after an hour

The scientists discovered that the use of ultrasound and microbubble-based opening of the blood-brain barrier is transient, and most of the blood-brain barrier integrity is restored within one hour after this procedure in humans.

“There is a critical time window after sonification when the brain is permeable to drugs circulating in the bloodstream,” said Sonabend, also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Previous human studies showed that the blood-brain barrier is completely restored 24 hours after brain sonication, and based on some animal studies, the field assumed that the blood-brain barrier is open for the first six hours or so. The Northwestern study shows that this time window might be shorter.

In another first, the study reports that using a novel skull-implantable grid of nine ultrasound emitters designed by French biotech company Carthera opens the blood-brain barrier in a volume of brain that is nine times larger than the initial device (a small single-ultrasound emitter implant). This is important because to be effective, this approach requires coverage of a large region of the brain adjacent to the cavity that remains in the brain after removal of glioblastoma tumors.

Clinical trial for patients with recurrent glioblastoma

The findings of the study are the basis for an ongoing phase 2 clinical trial the scientists are conducting for patients with recurrent glioblastoma. The objective of the trial — in which participants receive a combination of paclitaxel and carboplatin delivered to their brain with the ultrasound technique — is to investigate whether this treatment prolongs survival of these patients. A combination of these two drugs is used in other cancers, which is the basis for combining them in the phase 2 trial.

In the phase 1 clinical trial reported in this paper, patients underwent surgery for resection of their tumors and implantation of the ultrasound device. They started treatment within a few weeks after the implantation.

Scientists escalated the dose of paclitaxel delivered every three weeks with the accompanying ultrasound-based blood-brain barrier opening. In subsets of patients, studies were performed during surgery to investigate the effect of this ultrasound device on drug concentrations. The blood-brain barrier was visualized and mapped in the operating room using a fluorescent dye called fluorescein and by MRI obtained after ultrasound therapy.

“While we have focused on brain cancer (for which there are approximately 30,000 gliomas in the U.S.), this opens the door to investigate novel drug-based treatments for millions of patients who suffer from various brain diseases,” Sonabend said.

Other Northwestern authors include: A. Gould, C. Amidei, R. Ward, K. A. Schmidt, D.Y. Zhang, C. Gomez, J.F. Bebawy, B.P. Liu, I.B. Helenowski, R.V. Lukas, K. Dixit, P. Kumthekar, V. A. Arrieta. Lesniak, H. Zhang and R. Stupp.

The work is funded by the National Cancer Institute of the National Institutes of Health, the Lou and Jean Malnati Brain Tumor Institute of the Lurie Cancer Center and SPORE support from the Moceri Family Foundation and the Panattoni family.

Northwestern Medicine scientists report results of the first in-human clinical trial in which they used a novel, skull-implantable ultrasound device to open the blood-brain barrier and repeatedly permeate large, critical regions of the human brain to deliver chemotherapy that was injected intravenously.

Powerful Chemotherapy Drug Reaches Brain Tumors Using Novel Ultrasound Technology

Cancers of the lung are the leading cause of cancer-related deaths in the United States with more people dying of lung cancer than colon, breast and prostate cancers combined. 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 

. 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.

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. 

Northwestern Medicine Successfully Performs Double-lung Transplant on a Second Patient With Stage 4 Lung Cancer and Launches First-of-its-kind Clinical Program