Can a lung transplant save patients with advanced lung cancer?

Can a lung transplant, a procedure that for years was hardly considered an option for patients with advanced lung cancer, become a treatment for a specific group of patients? A study published in the medical journal JAMA presents exceptional preliminary results among patients with stage 4 NSCLC lung cancer, whose disease was limited to the lungs and did not respond to medical treatment.

The study examined 98 patients with stage 4 NSCLC lung cancer who were suitable candidates for transplantation and also suffered from respiratory failure. Of these, 17 underwent a lung transplant, while 81 patients who did not undergo a transplant due to non-biological barriers continued to receive medical treatment.

100% estimated survival after one year

The results indicated a significant gap between the groups: the estimated overall survival rate after one year was 100% among the 17 patients who underwent a lung transplant, with no deaths during the first year, compared to 40.8% among patients who received medical treatment only. The figure takes on special significance because lung transplantation is not currently considered a routine treatment for stage 4 lung cancer. The main concern over the years has been that the cancerous disease would return or spread after the transplant, especially given the need for immunosuppressive therapy afterward.

However, the researchers examined an exceptional population: patients whose cancer was limited to the lungs despite being defined as stage 4 disease, did not respond to existing treatments, and led to severe impairment of lung function. In such a situation, the possibility arises that replacing the diseased lungs may effectively remove the focus of the disease and prevent death as a result of respiratory failure.

Not suitable for every patient

Alongside the encouraging data, the researchers emphasize that it is still too early to consider lung transplantation an accepted treatment for stage 4 lung cancer. This is a study conducted at a single medical center and on a very small group of 17 transplant recipients, who were selected after a rigorous evaluation process. Follow-up is also still limited. In the extended follow-up, which lasted until the end of January 2026, two of the 17 recipients died. Therefore, further studies and long-term follow-up will be needed to understand whether the survival advantage is maintained over the years and what the risks of disease recurrence are after the transplant.

Despite the limitations, the study challenges a long-standing perception in the field of transplantation and oncology. If the findings are confirmed in larger studies, lung transplantation may in the future become a therapeutic option for a small and very well-defined group of patients with advanced lung cancer, for whom such an option previously hardly existed.