Advanced NSCLC Monotherapy Treatment


Hypothetical patients based on those studied in EMPOWER-Lung 1

Case discussion: Nonsquamous Stage IV NSCLC with bone metastases and
PD-L1 expression of 60%

No EGFR, ALK, or ROS1 aberrations

Meet Nora, 57 years old

Advanced NSCLC Hypothetical Patient Portrayal Nora
Hypothetical patient profile

Reasons for visit

  • Dry cough
  • Difficult breathing
  • Mild fatigue for ~6 months

Medical history

  • Osteoprosis, dyslipidemia, and asthma
  • ECOG PS 1
  • Active smoker (30 pack-years)
  • Treatment-naive

Social support

  • Lives alone and has limited support

Clinical information: Imaging and staging

Tumor locations

Tumor locations demonstrated on skeletal X-ray Tumor locations demonstrated on skeletal X-ray
  • Ipsilateral hilar lymph node involvement
  • Primary tumor: 3.5-cm mass in the left-lower lobe with small pleural effusion (asymptomatic)
  • Bone metastases in the thoracic spine (asymptomatic)
  • Bone metastases in the right ilium (asymptomatic)
  • For illustrative purposes only.

  • Chest X-ray revealed an opacity in the left-lower lung
  • Follow-up CT scans confirmed the presence of a 3.5-cm diameter mass in the lower lobe of the patient's left lung, evidence of pleural effusion in the left lung, and lesions in the spine and pelvis consistent with bone metastases
  • PET-CT scan revealed FDG avidity in all lesions
  • MRI revealed no brain metastases
  • Stage IVB
  • TNM staging was T2aN1M1c
Compound microscope

Clinical information:

  • Biopsy of the ipsilateral hilar lymph node confirmed adenocarcinoma with the majority of cells positive for napsin A and TTF-1
  • Plasma and tissue NGS were unremarkable for actionable driver mutations, including EGFR, ALK, and ROS1
  • PD-L1 expression by IHC 22C3 pharmDx assay was 60%

Patient’s considerations for treatment:

Patient apprehensive to treatment with chemotherapy

  • 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, Nora 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 Nora.

See EMPOWER-LUNG 1 Study Design