Advanced NSCLC Monotherapy Treatment


Hypothetical patients based on those studied in EMPOWER-Lung 1

Case discussion: Nonsquamous Stage IV NSCLC with brain metastases*
and PD-L1 expression of 70%

No EGFR, ALK, or ROS1 aberrations

*Treated and clinically stable brain metastases

Meet Bryan, 64 years old

Advanced NSCLC Hypothetical Patient Portrayal Bryan
Hypothetical patient profile

Reasons for visit

  • Visual disturbances and headaches
  • Recent weight loss (minimal)
  • Easily fatigued for ~6 months

Medical history

  • Well-controlled hypertension
  • ECOG PS 1
  • Former smoker (40 pack-years); quit 4 years ago
  • Treatment-naive

Social support

  • Lives with his wife and near his children

Clinical information: Imaging and staging

Tumor locations

Tumor locations demonstrated on skeletal X-ray Tumor locations demonstrated on skeletal X-ray
  • Brain metastases: 3 lesions (0.5 cm to 1 cm) in the left-frontal and parietal lobes with edema
  • Ipsilateral hilar and mediastinal adenopathy
  • Primary tumor: 4.8-cm right-upper lobe
    mass close to the pulmonary hilum
  • For illustrative purposes only.

  • Chest X-ray revealed an opacity in the right-upper lung
  • Follow-up CT scans confirmed the presence of a 4.8-cm diameter mass in the upper lobe of the patient's right lung close to the pulmonary hilum
  • MRI revealed multiple brain metastases
  • PET-CT scan revealed FDG avidity in all lesions
  • Stage IVB
  • TNM staging was T2bN2M1c
Compound microscope

Clinical information:

  • Biopsy of the right-upper lobe mass confirmed adenocarcinoma (TTF-1 positive)
  • Plasma and tissue NGS were unremarkable for actionable driver mutations, including EGFR, ALK, and ROS1
  • PD-L1 expression by IHC 22C3 pharmDx assay was 70%

Brain metastases first treated to resolve symptoms:

Clinically stable brain metastases following stereotactic radiosurgery and 2-week course of corticosteroids, which resolved headaches and visual symptoms

  • ALK=anaplastic lymphoma kinase; CT=computed tomography; ECOG=Eastern Cooperative Oncology Group; EGFR=epidermal growth factor receptor; FDG=fluorodeoxglucose; IHC=immunohistochemistry; MRI=magnetic resonance imaging; NGS=next generation sequencing; PD-L1=programmed death ligand 1; PET=positron emission tomography; ROS1=ROS proto-oncogene 1, receptor tyrosine kinase; TTF-1=thyroid transcription factor-1.

Based on this clinical information, Bryan is a potential candidate for LIBTAYO monotherapy.

Review the data from EMPOWER-Lung 1 to help you understand how LIBTAYO may be appropriate for patients like Bryan.

See EMPOWER-LUNG 1 Study Design