Single-center prospective study of lung transplant for refractory lung-limited stage IV non-small cell lung cancer

Patients with medically refractory, lung-limited, stage IV NSCLC ofte die of progressive respiratory failure. Although lung transplant offers the possibility of organ-level disease extirpation, the surgery has historically not been offered to such patients due to concerns of poor oncological outcomes. A prospective study at Northwestern University (Chicago, IL) investigated outcomes among adult patients who underwent lung transplant compared with medical management alone. All patients who underwent lung transplant had respiratory failure. In this study, 17 of 98 patients with stage IV NSCLC underwent lung transplant. The Kaplan-Meier estimated 1-year overall survival was 100.0% (95% CI 63.1-100.0) among the lung transplant recipients versus 40.8% (29.6-53.1) among the 81 patients who received medical management alone (absolute difference 59.2 percentage points; 95% CI 46.2-71.7). Among 306 patients without cancer who received lung transplant for end-stage pulmonary disease, the 1-year overall survival was 88.1% (95% CI 83.7-91.4) with an absolute difference versus NSCLC patients undergoing lung transplant of 11.9 percentage points (90% CI 9.1-15.5). The authors conclude that among selected patients with medically refractory, lung-limited, stage IV NSCLC and respiratory failure who underwent lung transplant, early survival was favorable. Longer-term follow-up and quality-of-life assessment are needed.