Pharmacogenomic & Phase II Study of Gemcitabine and Pemetrexed in Non-Small-Cell Lung Cancer.

Inclusion Criteria:

• Microscopically confirmed non-small cell carcinoma of the lung, which may be confirmed at the initial bronchoscopy and mediastinoscopy, or by transthoracic needle biopsy.
• No prior therapy for lung cancer.
• Patients must have disease stages IB (T2N0M0), IIA (T1N1M0), IIB (T2N1M0 and T3N0M0), or IIIA (T3N1M0 and T1-3N2M0). Patients with 2 lesions in one lobe (T4) (Stage IIIB) are eligible.
• Patients must be deemed medically fit for surgical resection by a thoracic surgeon.
• Patients must have an ECOG performance status of Zero or One.
• Patients must have measurable or evaluable disease.
• Measurable Disease: Any mass reproducibly measurable in one diameter (RECIST criteria).
• Evaluable disease: Lesions apparent on chest CT, which do not meet the criteria for measurability. These include ill-defined masses associated with post obstructive changes.
• Age >18 years.
• Patient must be able to understand and sign the informed consent.
• Patients must be >12 weeks from prior major surgery, such as a coronary artery bypass graft.

Exclusion Criteria:

• White blood cell count <3000/mm3
• Platelet count <100,000/mm3
• Hemoglobin <9.0 g/dl
• Creatinine >1.5 mg/dl
• Total bilirubin >1.5 mg/dl
• SGOT, SGPT, or AP >1.5 x upper limit of normal
• Metastatic disease (except peribronchial/hilar lymph nodes=N1 and ipsilateral/subcarinal mediastinal lymph nodes=N2) or malignant pleural effusion detected on preoperative evaluation. Non-malignant effusions are cytology negative, are non-bloody, and are transudates. Effusions visible only on CT and not large enough for safe thoracentesis will not result in ineligibility. Exudative effusions, even if cytologically negative are excluded. Pleural fluid is considered exudative if: the ratio of pleural fluid protein to serum protein is >0.5 or the ratio of pleural fluid LDH to serum to serum LDH >0.6 or Pleural fluid LDH is >200 IU/liter. A staging PET scan will be used to exclude patients. If there are multiple areas of FDG uptake outside the area of the primary tumor and the hilar and ipsilateral mediastinal lymph nodes, the patient will be excluded by virtue of having metastatic disease. If however, only one area shows an increase in FDG uptake, the area of concern will need further evaluation such as a biopsy to exclude metastatic disease.
• N3 lymph nodes (contralateral mediastinal/hilar and supraclavicular/scalene) or T4 primary tumor (malignant pleural effusion or mediastinal invasion) by clinical staging criteria (N3 as seen on CT or PET scan, which may be proven by mediastinoscopy at the investigators discretion).
• Pregnancy.
• Other active malignancy within 2 years with the exceptions of non-melanoma skin cancer and cervical carcinoma in situ.
• Psychologic, familial, sociologic, or geographic conditions, which do not permit biweekly medical follow-up and adherence to the study protocol.
• Prior radiation therapy for any cancer to the thorax.