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Lung Transplant May Improve Outcomes in Stage IV Lung Cancer

Some people with advanced non-small cell lung cancer (NSCLC) may benefit from receiving a double lung transplant, according to a study published in JAMA. People with advanced cancer typically have not been considered candidates for an organ transplant due to the risk for recurrence and the high mortality rate for people with stage IV disease, STAT reported. However, after completing lung transplants for people with COVID-19, surgeons at Northwestern Medicine in Chicago wondered if the same procedure could work for certain people with lung cancer. The study involved 98 people with unresectable lung-limited stage IV NSCLC—meaning the disease was in both lungs but had not spread to other parts of the body. Of those 98 people, 17 underwent a double lung transplant, and 81 had standard chemotherapy, immunotherapy or radiation. Additionally, 306 people who did not have lung cancer but had end-stage pulmonary disease also received a lung transplant. The estimated one-year survival among people with NSCLC who underwent transplant was 100%, compared with 40.8% of people with cancer who had standard care. Among the people without cancer who underwent a transplant, 88.1% remained alive in the same timeframe. In extended follow-up of the people with NSCLC who had a transplant, four people had a cancer recurrence, and two died from causes unrelated to cancer. In an accompanying editorial, Ece Cali Daylan and Ramaswamy Govindan, oncologists at Siteman Cancer Center in St. Louis, cautioned that longer follow-up is needed to evaluate how the procedure impacts survival. They also noted ethical concerns. People with advanced cancer are expected to have shorter lifespans than most people, so some believe another patient who is expected to live longer should receive the donor organs instead. The researchers, however, said the initial findings suggest the approach could be a viable option for treating people with this type of NSCLC. “Now we’ll have to see what the long term plays out, but at least the early results have no concerns that this would be not a good use of organs,” Ankit Bharat, a study author and a thoracic surgeon at Northwestern Medicine, told STAT.

For more on the procedure, read Cancer Today’s profile of Albert Khoury, one of the first people with NSCLC to receive a double lung transplant at Northwestern.

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LGBTQ+ Individuals Often Do Not Receive Key Cancer Screenings

LGBTQ+ people are less likely to undergo screening for breast and cervical cancers than heterosexual, cisgender women, according to a study published in Cancer. Looking at data from a national survey of U.S. adults, researchers analyzed responses from 663,924 people eligible for breast, cervical or colorectal cancer screening. Of the respondents, 8,108 identified as a sexual orientation minority, and 2,315 were gender identity minorities, Healio reported. Researchers found sexual orientation minority women were 16% less likely to be up to date on breast cancer screening and 8% less likely to be current on cervical cancer screening than heterosexual women. People who were gender identity minorities were 76% less likely to be up to date on breast cancer screening and 42% less likely to be current on cervical cancer screening than cisgender women. For colorectal cancer screening, sexual orientation minority men were slightly more likely to be up to date than heterosexual men, and there was no difference based on gender identity. Researchers said the results highlight that LGBTQ+ people often face barriers that prevent them from receiving cancer screening. They called for more research on these disparities, for health care systems to foster gender-affirming environments and for doctors to have regular conversations with all patients about screening. “For clinicians who have patients who are part of the sexual orientation or gender identity minority subgroup, a more detailed conversation is necessary about what organs need to be screened based on their sex assigned at birth and their current self-identified gender,” Timothy M. Pawlik, the study’s senior author and a surgical oncologist at Ohio State University Comprehensive Cancer Center in Columbus, told Healio.

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Antibiotics, Acid Reflux Drugs Linked to Decreased Immunotherapy Effectiveness in Lung Cancer

Antibiotics and medications commonly used to treat acid reflux may limit the effectiveness of immunotherapy drugs in people with lung cancer, according to a study published in Lancet Oncology. Researchers analyzed data from a phase III clinical trial that led to the approval of the immune checkpoint inhibitor Imfinzi (durvalumab) for unresectable stage III non-small cell lung cancer (NSCLC). In the new analysis, researchers looked at outcomes for 660 participants, 449 of whom received Imfinzi and 211 of whom received a placebo. Of these 660 people, 10% were taking an antibiotic at the start of the trial, and 40% were using a proton pump inhibitor. These drugs, which include Nexium (esomeprazole), Prevacid (lansoprazole) and Prilosec (omeprazole), treat chronic acid reflux, stomach ulcers and other gastrointestinal conditions by reducing the amount of stomach acid the body produces. Among patients who received Imfinzi, people who took antibiotics had a 6.4-month shorter median progression-free survival than those who did not, but there was no significant change in overall survival. Additionally, people who took a proton pump inhibitor had a 7.8-month shorter median progression-free survival and a 24.9-month shorter median overall survival than those who did not. The results align with previous research that has suggested proton pump inhibitor use can lead to worse outcomes in people taking immune checkpoint inhibitors, possibly because these drugs may disrupt the microbiome, MedPage Today reported. “These findings suggest that commonly prescribed supportive medications such as proton pump inhibitors and antibiotics could be associated with attenuation of benefit from consolidation immunotherapy in patients with unresectable stage III NSCLC,” the researchers wrote. “Given the curative intent of treatment in this setting, these results underscore the importance of careful evaluation of concomitant medications when clinically appropriate.”