Advanced NSCLC Monotherapy Treatment


Hypothetical patients based on those studied in EMPOWER-Lung 1

Case discussion: Squamous locally advanced NSCLC and
PD-L1 expression of 90%

No EGFR, ALK, or ROS1 aberrations

Meet Liang, 75 years old

Advanced NSCLC Hypothetical Patient Portrayal Liang
Hypothetical patient profile

Reasons for visit

  • Coughing and weight loss for 6 months
  • Dull, achy, left-sided chest pain for the past month

Medical history

  • Hyperlipidemia, hypercholesterolemia, and COPD (FEV1 ratio <1L; receiving 2L/min of O2)
  • ECOG PS 1
  • Former smoker (20 pack-years); quit 6 years ago
  • Not a candidate for surgical resection or definitive chemoradiation

Social support

  • Lives with his wife

Clinical information: Imaging and staging

Tumor locations

Tumor locations demonstrated on skeletal X-ray Tumor locations demonstrated on skeletal X-ray
  • Satellite nodules in the left-upper lobe
  • Ipsilateral and contralateral mediastinal adenopathy
  • Primary tumor: 5.5-cm mass in the left-
    upper lobe
  • For illustrative purposes only.

  • CT scans revealed the presence of a 5.5-cm diameter mass and multiple satellite lesions in the upper lobe of the patient's left lung and evidence of ipsilateral and contralateral mediastinal adenopathy
  • MRI revealed no brain metastases
  • PET-CT scan revealed FDG avidity in all lesions
  • Stage IIIC
  • TNM staging was T3N3M0
Compound microscope

Clinical information:

  • Biopsy of the mediastinal lymph nodes confirmed poorly differentiated squamous cell carcinoma
  • Plasma and tissue NGS were unremarkable for actionable driver mutations, including EGFR, ALK, and ROS1
  • PD-L1 expression by IHC 22C3 pharmDx assay was 90%

Ineligible for surgery or chemoradiation:

Case was reviewed by the multidisciplinary tumor board and this patient was deemed to be ineligible for surgical resection or definitive chemoradiation due to extent of disease

  • ALK=anaplastic lymphoma kinase; CT=computed tomography; ECOG PS=Eastern Cooperative Oncology Group performance status; EGFR=epidermal growth factor receptor; FDG=fluorodeoxglucose; FEV1=forced expiratory volume in 1 second; 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, Liang 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 Liang.

See EMPOWER-LUNG 1 Study Design