Abstract CT163: Double lung transplantation in patients with metastatic lung-limited non-small cell lung carcinoma (NSCLC): A case series

Abstract Background: The role of double lung transplantation (DLT) in patients with advanced bilateral lung-limited non-small cell lung cancer (NSCLC) has been a subject of debate. We present a prospective study involving patients who underwent DLT for this indication. Methods: Patients treated with DLT for advanced bilateral lung-limited NSCLC were identified between September 2021 and December 2024 at Northwestern Memorial Hospital. All patients were enrolled in the DLT registry for lung-limited malignancies (DREAM) study cohort A (NCT05671887). Exclusion criteria included the presence of extrapulmonary disease. The indication for DLT was cancer refractory to available systemic treatments, with or without respiratory failure. Results: Eleven patients with advanced bilateral lung-limited NSCLC were included; the median age was 62 years (range 37-71). Two patients (18%) were Asian, eight (73%) were White, one was Black (9%), Six (55%) were female, and three (27%) had a history of smoking. Seven patients (64%) had invasive mucinous adenocarcinoma, and four patients (36%) had invasive non-mucinous adenocarcinoma histology. The median number of pretransplant treatment lines was 3 (range 1-8). All patients experienced disease progression on standard-of-care treatments, with or without participation in clinical trials. The median duration of the waitlist for DLT was 18 days (range 5-414). There was no 30-day mortality. Only one patient experienced a recurrence at 18 months post-DLT, presenting with a 1 cm solid nodule, successfully treated with stereotactic body radiotherapy. Furthermore, the explant pathology revealed malignant cells in the mediastinal and hilar lymph nodes in two patients. With a median follow-up of 16 months (range 1-39), there were no cases of rejection, no patients required oxygen therapy, and all patients remained alive at the time of reporting. Conclusions: Eleven patients with NSCLC underwent DLT successfully without experiencing any significant complications. All patients have survived, with one patient receiving curative treatment after a recurrence, while the remaining patients are currently under observation. Citation Format: Young Kwang Chae, Chitaru Kurihara, Tarik Demir, Liam Il-Young Chung, Wongi Woo, Carolyn Moloney, Brooke Sanson, Rose Dwyer, Chan Mi Jung, Rade Tomic, Ankit Bharat. Double lung transplantation in patients with metastatic lung-limited non-small cell lung carcinoma (NSCLC): A case series [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr CT163.