The Organ Transplant Revolution Starts Here - Chasing Life with Dr. Sanjay Gupta - Podcast on CNN Audio

Dr. Sanjay Gupta
00:00:03
What you're about to hear is a story of history in the making.
Dr. Sanjay Gupta
00:00:20
A medical first, a story of survival, bravery, and heroism. I'm not a hero.
Dr. Sanjay Gupta
00:00:29
To try and solve a crisis. Taking the clamp off the artery. Nice and pink, yeah. You see, at any given moment, more than 100,000 people are waiting.
Dr. Sanjay Gupta
00:00:56
And every day 17 people sadly will die.
Speaker 2
00:01:00
For any organ that you name. Only 10% make it on the list. There's just not enough of. There's not enough.
Dr. Sanjay Gupta
00:01:06
Now, the potential answer to this problem might sound crazy to many.
Speaker 7
00:01:10
I have received a major, major, groundbreaking organ transplant.
Dr. Sanjay Gupta
00:01:19
Controversial to some
Speaker 7
00:01:21
for that animal. This is a life of deprivation. It's an early death. It is much suffering. I don't think that's ever okay.
Dr. Sanjay Gupta
00:01:28
Even blasphemous to others.
Speaker 5
00:01:30
Contacted the bishop and then the Vatican sent me a paper
Dr. Sanjay Gupta
00:01:34
But now, more than ever, it's also incredibly promising. Could animals be the answer? Is it right? Is it wrong? Can it even work?
Dr. Sanjay Gupta
00:01:49
That is an ultrasound with a pig kidney inside Tim, something that very few
Dr. Sanjay Gupta
00:01:54
people ever get to see. For the last two years, we've been searching for answers.
Dr. Sanjay Gupta
00:02:01
It's powerful just to be here with these pigs.
Dr. Sanjay Gupta
00:02:05
I'm Dr. Sanjay Gupta, and here is part one of Animal Farm. In the remote mountains of Patagonia, about as far from civilization as you can get, Robert Montgomery almost died.
Robert Montgomery
00:02:22
I had a cardiac arrest and my son was doing CPR on me and they put me in the back of a truck and drove me to a hospital and they looked at me and said we can't take care of this. They brought an ambulance up and continued resuscitation and drove five hours to the closest hospital.
Dr. Sanjay Gupta
00:02:47
I've heard a lot of extraordinary stories throughout my career, but just the idea, the cardiac arrest, and then your son doing chest compressions on you.
Robert Montgomery
00:02:54
Yeah, he saved my life. When I woke up I couldn't do anything, I couldn't walk or talk.
Dr. Sanjay Gupta
00:03:09
That he even survived. It really is just so extraordinary. But still, the underlying problem, something known as dilated cardiomyopathy, where the heart is just too weak to adequately pump blood, that was still with him, lurking, constantly threatening his life.
Robert Montgomery
00:03:28
Father died at 52 from cardiomyopathy, the same disease that I had. Brother dropped dead at 35. Another brother got a heart transplant at 39. And then me. I basically accepted that I might not live a normal lifespan.
Dr. Sanjay Gupta
00:03:51
Almost every single man in his family, sick or dying of this heart disease. Was it your father's doctor who said that transplantation really wasn't going to be a solution?
Robert Montgomery
00:04:04
My mother was really begging him to come up with something, and he said, you know, he's too old and...
Dr. Sanjay Gupta
00:04:12
52
Robert Montgomery
00:04:13
52 and it doesn't work anyway, so you wouldn't want that. That was 1976
Dr. Sanjay Gupta
00:04:20
Even though the first successful heart transplant was back in 1967 in South Africa, it would take decades for it to become widely available. Not in time for Dr. Montgomery's dad. And so Robert Montgomery was given a mission, become a transplant surgeon, and hopefully one day save people just like his dad.
Robert Montgomery
00:04:43
Alright, how does that look with the camera?
Dr. Sanjay Gupta
00:04:45
'It wasn't easy. By age 56, he had had three near-catastrophic cardiac arrests himself. The only cure, he was told, was a heart transplant.
Robert Montgomery
00:04:56
For any organ that you name, only 10% make it on the list. I wasn't sick enough to get on the lists. You have to get so sick before you would even qualify to be in the running to receive an organ. And it's just unacceptable.
Dr. Sanjay Gupta
00:05:12
And that's all because we have to ration organs. There's just not enough of them.
Robert Montgomery
00:05:17
There's just not enough.
Dr. Sanjay Gupta
00:05:18
But then it was the summer of 2018 when Robert Montgomery suddenly became sick enough. Once again, he was overseas. This time it was Italy, with his wife Denise.
Denise Montgomery
00:05:30
Have four heart attacks that
Robert Montgomery
00:05:32
I just had one cardiac arrest after another. They gave me last rights.
Denise Montgomery
00:05:39
They revived him. He said I will die if I don't get out of here.
Robert Montgomery
00:05:43
They left my IVs underneath my shirt and they gave my friend a bundle of preloaded resuscitation drugs and syringes and flew back because I knew that was my ticket.
Dr. Sanjay Gupta
00:05:58
The odds of survival were still not in his favor.
Robert Montgomery
00:06:02
Hi sweetheart
Dr. Sanjay Gupta
00:06:03
'You see, even after making it on the list, 17 people die every day while waiting. Remarkably, just three weeks later, a heart became available. But it came with a catch. His donor had died of a heroin overdose, and the heart was infected with hepatitis C. In the transplant world, that is typically a no-go. In fact, thousands of hep C-infected organs are discarded every year. But Dr. Montgomery insisted that his doctors still give it to him.
Robert Montgomery
00:06:35
We had just done a study showing that you could take a hepatitis C positive organ and put it into a hepatitis C negative recipient and treat them with these new antivirals. You could successfully treat the virus.
Denise Montgomery
00:06:47
Robert wasn't worried, and so I was.
Dr. Sanjay Gupta
00:06:52
It was a risk, transplanting an infected organ into someone who had his immune system suppressed. But you're probably starting to see a pattern here. Montgomery was once again willing to take the chance and prove that these infected hearts could be used safely.
Robert Montgomery
00:07:09
Hello to all my friends. And it worked. Thank you for your kind thoughts and your prayers, and I'm making a very nice recovery.
Dr. Sanjay Gupta
00:07:18
Within weeks, he was able to walk out of the hospital. Today, he wants to show me the place he comes to treat patients, just like him.
Robert Montgomery
00:07:27
I was in this room right around the corner, so I have good feelings about this place actually. It's like hope. Yeah, it's hope. It represents hope. Behind that door, yeah.
Denise Montgomery
00:07:37
He is a man on a mission. He wants to see this eradicated.
Robert Montgomery
00:07:43
If this were like a cancer drug, we wouldn't allow something to be rationed like this, right? We just don't have any choice right now. So we need another choice.
Dr. Sanjay Gupta
00:07:52
Another choice which Montgomery is now racing to find.
Tim Andrews
00:07:57
I'll help you down.
Dr. Sanjay Gupta
00:07:58
Another choice, hopefully, for this man. Tim Andrews has been living with diabetes since the 1990s, successfully managing it with insulin. Retired and happily married to his second wife, Karen, these empty nesters had big plans for their new life together, traveling the world, until one day in 2022.
Tim Andrews
00:08:19
I got tired, I was like, oh my god, I'm gonna fall asleep or something. So I was checked and they said, oh yeah, stage three, kidney failure. Oh, okay. And a month later they're telling me, I am at end stage. Wow, just one month. Just one month, just quit on it.
Dr. Sanjay Gupta
00:08:38
And what were you feeling like at that point?
Tim Andrews
00:08:40
I mean, I was told, literally told, you have dialysis or you pick a box.
Dr. Sanjay Gupta
00:08:50
It was a false choice, certain death or dialysis, meaning being dependent on a machine for the rest of his life.
Tim Andrews
00:08:59
The first couple of months was like, hey, this is not gonna be so bad. As time went on, like six months in, I had a heart attack. It takes a toll on you emotionally and physically.
Tim Andrews
00:09:29
This is where I get to sit. Without it, six weeks, eight weeks later, I'd be dead. It's a necessary evil.
Dr. Sanjay Gupta
00:09:37
Necessary at least until he could get a kidney transplant. But again, just as with Montgomery, he knew that could take a while, might never happen, and the clock was ticking. I was ready to die in this chair. And that is when he learned about another option, brand new, still relatively untested.
Speaker 11
00:09:58
Some people said, there's not enough information. Don't do this yet. Don't this yet."
Dr. Sanjay Gupta
00:10:09
You can't really tell by looking at them, but these tiny piglets have been genetically engineered to make their organs more acceptable for transplantation into humans. It's something known as xenotransplantation.
Dr. Sanjay Gupta
00:10:22
So Mike, how unusual is it for us to even be here?
Mike Curtis
00:10:25
This is very unusual. We usually try to limit this to only the staff that takes care of the animals.
Dr. Sanjay Gupta
00:10:31
Mike Curtis is the CEO of biotech company eGenesis. Never before has he let cameras onto this very special pig farm.
Mike Curtis
00:10:40
Everything's controlled, like all of the feed is clean, water's clean, the staff is clean.
Dr. Sanjay Gupta
00:10:45
And I should just point out that I walked into a room, turned on a filter, essentially cleaned the air for five minutes before I could then go shower. That's why my hair is wet. I put on everything new here, including underwear, socks, shoes.
Dr. Sanjay Gupta
00:10:59
The goal is to protect the pigs from us.
Dr. Sanjay Gupta
00:11:14
You know, I got to tell you, I did not know what to expect, but it's powerful just to be here with these pigs.
Dr. Sanjay Gupta
00:11:23
After all, these pigs are among the most genetically modified mammals on the planet.
Mike Curtis
00:11:29
These piglets carry a total of 69 edits to the genome.
Dr. Sanjay Gupta
00:11:34
Alterations to their DNA.
Mike Curtis
00:11:37
We're trying to reduce the risk of disease transmission from the porcine donor to human, we're editing in a way that reduces or eliminates hypercute rejection, and then we add human regulatory trans genes to control rejection.
Dr. Sanjay Gupta
00:11:50
'To do that, scientists take the unedited pig cells and use a gene editing tool called CRISPR. They add special CRISPR fluids to the cells, which splices out certain genes and adds other genes. You can't really see anything with the naked eye and it takes only seconds, but what is happening in this vial is truly remarkable. Let me take a second and explain. First of all, remember that all DNA is made up of four chemical bases, A, C, G and T. Think of that as your genetic blueprint. Now, a pig's DNA and a human's DNA, they actually look pretty similar, but there are some important differences. For example, the GGTA1 gene that is responsible for a carbohydrate that forms around a pig cell known as alpha-gal. Now if you put that into a human, it would cause almost instantaneous rejection. But by knocking out that specific sequence and then adding in others. Scientists can make the pig's organs much more compatible for humans.
Mike Curtis
00:12:55
So in the freezer are all these cells that we've edited. We thaw that vial, we grow those cells, and then we take the nucleus from that edited cell and we transfer it. It's akin to what was done with Dolly back in the 90s, cloning.
Dr. Sanjay Gupta
00:13:09
'And that is the process by which they have created a modern-day assembly line of genetically modified pigs.
Mike Curtis
00:13:17
We've selected the Yucatan Mini Pig because fully grown, they're about 70 kilos, 150 pounds. Right, so the organs are correctly sized for a human recipient.
Dr. Sanjay Gupta
00:13:27
Ultimately, you've got to get the size right.
Dr. Sanjay Gupta
00:13:31
Now, if the idea of using animals for human transplants sounds familiar to you, it's because the concept has been around for a long time. There have been at least 48 cases reported in the medical literature since the 1900s. You may remember one of the most famous.
Robert Montgomery
00:13:46
This is Baby Faye.
Dr. Sanjay Gupta
00:13:47
Little baby Faye in 1984. She had a baboon heart that kept her alive for 20 days. But there was always the stubborn issue of rejection. And so for a long time, xenotransplants faded into the background.
Robert Montgomery
00:14:01
I think we've turned up the throttle significantly.
Dr. Sanjay Gupta
00:14:05
What's led to that?
Robert Montgomery
00:14:06
What we did is transplanted one of these organs into someone who had wanted to donate their organs was brain dead.
Dr. Sanjay Gupta
00:14:14
'You heard that right. The first human patients to receive the gene-edited pig kidneys were brain dead. Why? In order to move the field forward without moving too fast. First, the scientists just wanted to prove that pig organs could survive in a human body. Dr. Robert Montgomery performed that operation on Maurice Miller, who was brain dead
Robert Montgomery
00:14:39
We took the clamps off to let the blood go into the organ and it turned this beautiful pink color and started to make urine immediately.
Robert Montgomery
00:14:48
Pretty looking kidney.
Robert Montgomery
00:14:49
'That was mind-blowing. So it looks a lot like a human kidney.
Dr. Sanjay Gupta
00:14:54
In fact, when I first met Dr. Montgomery a few years ago, he was reviewing Maurice Miller's kidney biopsy. Here's what they learned. About a month into the transplant, the pig kidney did begin to show signs of rejection.
Robert Montgomery
00:15:08
See that red? Yes. That's hemorrhage.
Dr. Sanjay Gupta
00:15:11
'But importantly, standard anti-rejection drugs did work. And the kidney function is okay?
Robert Montgomery
00:15:18
It's back to normal.
Robert Montgomery
00:15:20
It gave, I think, the FDA some confidence that this was going to work in humans.
Dr. Sanjay Gupta
00:15:27
'With all that research in the background, in 2022, the University of Maryland School of Medicine announced the first xenotransplant into a living recipient, someone who is not brain dead. It would be a pig heart into 57-year-old David Bennett. Give me a high five, buddy. That was awesome.
David Ayers
00:15:46
We saw two months survival of that patient and now incrementally seeing longer and longer survival in these compassionate use patients.
Dr. Sanjay Gupta
00:15:55
David Ayers is a giant of a man. Seeing him on this farm in Blacksburg, Virginia, you may not know that he is also considered one of the most widely regarded geneticists in the world.
David Ayers
00:16:06
We have about 300 research animals here. We grow the designated pathogen free pigs that were ultimately used for the decedent studies, as well as the patients that have received our organs for transplant, both hearts and kidneys.
Dr. Sanjay Gupta
00:16:23
He's taking me to meet some of the farm's newest arrivals.
David Ayers
00:16:28
Watch your head, maybe that's just me.
Dr. Sanjay Gupta
00:16:34
There's a lot of piglets
David Ayers
00:16:37
Do you want to hold one? Yeah, sure. So these are ten gene Clone Piglets.
Dr. Sanjay Gupta
00:16:44
Here at United Therapeutics, they perform 10 gene edits on their pigs. Now remember, eGenesis in Wisconsin perform more than 60.
Dr. Sanjay Gupta
00:16:57
If you're doing 6 times as many edits does that make it much better?
David Ayers
00:16:58
I don't think more edits is necessarily better or worse. The additional 50 edits that eGenesis has done are to inactivate an endogenous pig virus. We've actually addressed that by breeding.
Dr. Sanjay Gupta
00:17:12
In 2024, the first pig kidney transplant was announced.
Speaker 14
00:17:16
My name is Dr. Leo Riella. I'm medical director of the kidney transplant program Mass General. Today, we announce the successful gene added to pay kidney transplant into a living human.
Dr. Sanjay Gupta
00:17:28
Tim Andrews, still on dialysis, was watching all of this unfold.
Tim Andrews
00:17:34
I'm like, oh, they're doing it at Mass General. And I was like, I have to be part of this. I'm not gonna make it, but I'll make it to this. And I'll tell you right up front, if it's one day and you learn something, thank God.
Dr. Riella
00:17:50
His eyes really sparked up and he said, tell me what I need to do.
Speaker 11
00:17:56
And they said, prepare your body for battle, because it's gonna be a battle. He had to do dental work, he had to go to physical therapy. We signed up for the gym. When he came back to see Dr. Riella, he had lost 22 pounds.
Dr. Sanjay Gupta
00:18:13
Did you have any doubts along the way?
Tim Andrews
00:18:16
You know, there's always doubt with it, but I'm like, this is my chance to do something.
Dr. Sanjay Gupta
00:18:23
You're going to be in medical history books forever.
Tim Andrews
00:18:27
Kids are going to be taught how to do it, watching me have one put in me.
Dr. Sanjay Gupta
00:18:33
They'll know your name.
Dr. Sanjay Gupta
00:18:38
It's a crisp January morning back at the Egenesis Pig Farm in Wisconsin.
Dr. Sanjay Gupta
00:18:44
It's been more than a year since our first visit.
Speaker 3
00:18:47
This is many years in the making. So Raphael, she'll be able to donate one of her kidneys to a man who's in dire need. And essentially, she's saving his life.
Speaker 15
00:18:59
Go, Raphael! It's a really big moment. There's a lot of emotions. We love our piglets like our own. Thinking about the purpose that Raphael is serving, like getting to go and give someone a new lease on life is just such a gift.
Dr. Sanjay Gupta
00:19:18
That someone is Tim Andrews. Raphael will be his donor.
Tim Andrews
00:19:25
What a gift.
Dr. Sanjay Gupta
00:19:30
'As Rafael departs for the 17-hour trip to Boston, Tim settles in at Mass General.
Tim Andrews
00:19:37
I knew I was in great hands, these guys are just so good.
Dr. Sanjay Gupta
00:19:42
Were you nervous the morning of?
Dr. Riella
00:19:45
And we'll see you on the other side, getting ready. As a new man. We're all anxious and nervous about going through a procedure that has not been done before. And having that reassurance from him also brings a lot of positivity to the entire team.
Dr. Sanjay Gupta
00:20:02
It's early morning, January 25th, when Dr. Riella and the surgical team travel about 50 miles outside of Boston to meet Rafael.
Dr. Riella
00:20:11
It was an OR, very similar to what we see in the hospital, and the surgery to retrieve the organs occur there. They look very similar to how we do procurements. I think uniqueness is really that, who was a donor, who was coming, yeah, it was a pig.
Dr. Sanjay Gupta
00:20:29
It's go time!
Speaker 11
00:20:30
It's a dance to get the pig kidney there and get him in the operating room.
Dr. Sanjay Gupta
00:20:37
They gotta coordinate it.
Speaker 11
00:20:37
So a nurse came and said, okay, good to go. I'm like, wait, wait. We haven't said goodbye. You can't say goodbye. Oh, yes, I can. So, I actually made them wait and they said, we've got to go, I'm saying goodbye to my husband before he leaves for surgery and he may not come back.
Speaker 17
00:21:00
It's a little chilly in here, okay, Tim?
Tim Andrews
00:21:01
I like cold.
Dr. Sanjay Gupta
00:21:02
The operation lasts a little over two hours, around the same as a traditional transplant, and the big kidney. It looks, feels, and functions very much like a human kidney. And here is when surgeons connect the pig kidney to Tim's artery and vein. After that, the moment of truth. Surgeons release the clamp so blood can flow into the kidneys and the organ turns pink. And now this, urine, successfully flowing through the kidneys.
Dr. Riella
00:21:36
Wow, look at that. We were very surprised. We were hoping that we would start making urine within a day or two, but seeing the urine being produced right away was not what at least I expected to be happening that close. Everything went well.
Speaker 11
00:21:53
They said, they put the kidney on the table and started connecting him to the kidney and he actually peed across the room. So they were very, very excited. Of course, I started bawling like a baby. We were all crying. I mean, we were all. oh my goodness, I mean, this is not the end, but we're getting there, we're getting there.
Tim Andrews
00:22:19
'I felt great and all of a sudden I had energy and I was like, this is beyond what I thought I was going to get. So right away you felt that coming? Right away I felt that. I was, like, look at me, I'm a new man, it was like a new birth, I said, I have a new birthday, 125-25 is my new birthday. Because I was alive and I hadn't been for a long time and I'm like, this is amazing.
Dr. Sanjay Gupta
00:22:57
But there was still a long way to go. This is still so experimental after all. And Tim and Karen knew how quickly things could change. It was just a year earlier that Lisa Passano also needed a kidney. Her daughter, Brittany Rydell, remembers just how sick her mother was.
Brittany Rydell
00:23:17
It means no more dialysis, hopefully.
Dr. Sanjay Gupta
00:23:20
'Like Tim, she was an end-stage kidney disease, but Lisa's heart was also failing. And that is why a traditional kidney transplant was not an option for her.
Dr. Sanjay Gupta
00:23:30
She was too sick.
Brittany Rydell
00:23:32
Yeah, absolutely.
Robert Montgomery
00:23:34
Lisa Passano was on death's door. I mean, she was not gonna live. You know, days to weeks from dying.
Dr. Sanjay Gupta
00:23:44
So Dr. Montgomery, who was her surgeon, suggested a pig kidney.
Robert Montgomery
00:23:48
But there are some people who are willing to take that chance, and she was one of them.
Dr. Sanjay Gupta
00:23:54
'In the spring of 2024, Lisa Pisano became one of the first two patients in the world to receive a gene-edited pig kidney transplant.
Brittany Rydell
00:24:02
I got more energy. I feel energized. After her kidney transplant, I have to say she looked the best that she looked in so I've seen her so happy. It was definitely the healthiest I had seen her in a while.
Dr. Sanjay Gupta
00:24:15
She was doing well at that point.
Brittany Rydell
00:24:17
Yeah, we were so hopeful, because I had seen her so much better, and I figured if anything was going to go wrong, it would have went wrong at that moment, and not months later.
Dr. Sanjay Gupta
00:24:28
Pesano developed several infections and never recovered enough to leave the hospital.
Brittany Rydell
00:24:33
I don't have regrets about the surgery, I just wish that she could have had the opportunity to really enjoy it more.
Dr. Sanjay Gupta
00:24:40
I know it's probably hard to sort of think of it this way, but she was a real pioneer.
Brittany Rydell
00:24:45
One of the first things she said to me was even if this doesn't work for me, it can work for someone else. And I think about that a lot.
Robert Montgomery
00:24:52
The first patient that we did was in this bed, in the bed that I was in, Lisa Passano. You know, taking care of that one life. And if they were just that, that would be great, but then you have this opportunity to really impact maybe thousands, maybe millions of lives.
Dr. Sanjay Gupta
00:25:11
Now Tim knew Lisa's story. He knew that there was a tremendous amount of uncertainty.
Tim Andrews
00:25:17
Stepping forward, you're gonna do something for humanity. This is a way that we can bring this forward. And this is the hope for all these people that it's gonna be okay. We're gonna find a way, which is amazing to me. It was just, I have to be part of this.
Dr. Sanjay Gupta
00:25:40
So would this be a success for Tim, and what does it all mean for the 100,000 people currently waiting?
Tim Andrews
00:25:47
There's bumps in the road.
Dr. Sanjay Gupta
00:25:48
We'll dive into that when we come back next week with part two of Animal Farm. Thanks for listening.

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• Associated Press

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In humid places, just use a fan. If you don't have air conditioning, find public places that do, including movie theaters, malls and libraries. Some communities set up cooling centers. Depending on where you live, the Low-Income Home Energy Assistance Program can help you buy a window air conditioning unit, according to the National Council on Aging . Some local nonprofits and civic organizations can also help you access one if cost is a burden. Know your rights if you work outside Knowing what workplace protections you have is important. But there are no federal heat rules to protect workers in the United States. Some states have them, including Washington, Oregon, California, Nevada, Colorado, Minnesota and Maryland, according to the National Resources Defense Council. Other states don't have any. If your state has work rules, try to learn them — though there are still challenges to ensuring regulations are actually enforced, said Bharat Venkat, director of the University of California, Los Angeles Heat Lab. He notes that sometimes shaded areas are too far for workers to take breaks without losing wages, or that management can make it impossible for workers to advocate for themselves. 'Most workers don't actually have control over their time or control over where they work,' he said. Within those constraints, finding ways to stay hydrated and lower your body temperature are paramount. You can do this by drinking lots of fluids, wetting clothing or putting cold water or a cold rag on your hands, feet, armpits and neck. A portable handheld fan or a cooling vest can also help. If you're exercising, avoid the hottest times of day and bring more water than you think you need. Knowing heat illness symptoms Heat illness symptoms can vary by person, Venkat said. Medications or underlying conditions can also make it harder to regulate body temperature or notice you're getting too hot. Early trouble signs include heavy sweating, muscle cramps and headache. That's when you stop what you're doing and cool yourself off — for example, by splashing yourself with cold water or finding an air conditioned space. As heat exhaustion sets in, new symptoms arrive, including faster heart rate and dizziness. Next comes heat stroke, which can include confusion, slurred words and fainting. Ward said that's when to call 911. 'Don't be embarrassed to call 911 or go to urgent care when you think you might have overdone it in the heat,' he said. ___ Walling reported from Chicago. Wells reported from Cleveland. ___ The Associated Press' climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP's standards for working with philanthropies, a list of supporters and funded coverage areas at .

Medscape

an hour ago

• Medscape

Key Abstracts in Early-Stage NSCLC From ASCO 2025

Dr Jonathan Goldman of the University of California, Los Angeles, highlights key abstracts in early-stage NSCLC from ASCO 2025. Dr Goldman begins with updated results from CheckMate 816, comparing neoadjuvant chemotherapy (chemo) vs chemo + nivolumab. Median overall survival (OS) in the nivolumab arm remains unreached vs 73.7 months with chemo alone. Event-free survival (EFS) is durable at 59.6 vs 21.1 months, as evidenced by 5-year EFS of 49% in the combination arm. Next, he reviews the NeoADAURA trial evaluating neoadjuvant osimertinib ± chemo in resectable EGFR-mutated stage II-IIIB NSCLC. Major pathologic response was higher in osimertinib-containing arms (26% and 25%) vs 2% in the chemo arm, although long-term outcomes remain pending. Dr Goldman also discusses the SWOG/NRG S1914 trial of perioperative stereotactic body radiotherapy ± atezolizumab, which did not show improvements in OS or progression-free survival (PFS). He then highlights a prospective, low-dose CT screening study of the Mississippi Delta cohort, which showed a 4.7% lung cancer detection rate overall and 4.5% in patients with incidental pulmonary nodules — underscoring the utility of low-dose CT as a modality in early detection. In closing, he reports on two studies in small cell lung cancer. The IMforte study showed that lurbinectedin + atezolizumab in 1L maintenance improved PFS (HR, 0.54). In the DeLLphi-304 study, second-line tarlatamab improved OS compared to chemo (HR, 0.6), which is a potentially practice-changing update.

Wall Street Journal

an hour ago

• Wall Street Journal

Health Insurers to Promise Changes to Preapproval Process That Drew Backlash

Following the backlash that hit health insurers after the killing of a top executive last year, the industry will pledge steps meant to smooth the controversial preapproval process that can deny or delay access to care. The initiative is set to be unveiled early next week, according to people familiar with the matter.