Erlotinib With or Without Fulvestrant in Treating Patients With Stage IIIB or Stage IV Non-Small Cell Lung Cancer

Inclusion criteria:

• adults over the age of 18 capable of giving informed consent.
• Histologically confirmed non-small cell lung cancer
• Stage IIIB or IV NSCLC
• Tumor tissue block available.
• ECOG performance status of 0, 1 or 2.
• Measurable disease by RECIST criteria defined as ≥ 1 target lesion that has not been irradiated. New lesions that have developed in a previously irradiated field may be used as sites of measurable disease provided all other criteria are met.
• Meets 1 of the following criteria:
• Progressive disease after ≥ 1 prior standard chemotherapy regimen
• Refused chemotherapy
• Unable to receive standard chemotherapy
• women of childbearing age must have negative pregnancy test by urine or serum prior to initiation of treatment. men and women of childbearing potential must consent to using adequate contraception throughout treatment and for 3 months following surgery.

Exclusion criteria:

• Renal insufficiency (serum creatinine >2mg/dl)
• Liver insufficiency (serum total bilirubin >1.5X ULN, or serum transaminases > 2.5X the ULN or %X ULN if hepatic metastases).
• hematologic abnormality platelets< 100,000 ANC <1,500/mm3
• THerapeutic anticoagulation will be allowed, but patients receiving fulvestrant while on therapeutic anticoagulation will have the fulvestrant dose divided into twice as many syringes to minimize the volume of intramuscular injection in these patients. In patients receiving low molecular weight heparin or fondaparinux, these medications should be held for 12 hours before and after fulvestrant injection if possible.
• Active CNS metastases.
• New York Heart Association class III or IV cardiac disease
• myocardial infarction within the past 12 months
• symptomatic ventricular arrhythmia
• symptomatic conduction abnormality
• evidence of clinically active interstitial lung disease
• Patients with asymptomatic chronic stable radiographic changes are eligible
• pregnant or nursing or inadequate contraception
• hypersensitivity to erlotinib hydrochloride or fulvestrant or to any of their excipients
• comorbid disease or medical condition that would preclude study treatment or compliance
• malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
• chemotherapy or non-cytotoxic investigational agents within 4 weeks of initiating treatment.
• major surgery within 4 weeks of initiating therapy. Minor surgery within 7 days of initiating therapy.
• anticancer antiestrogen therapy. Concurrent stable-dose steroids allowed
• concomitant radiation therapy to the lungs. Radiation therapy to non-target lesions will be allowed as long as it is completed 1 week prior to initiation of treatment.
• prior anticancer epidermal growth factor receptor inhibitors
• concurrent CYP3A4 inducers, including any of the following:
• Phenytoin
• Carbamazepine
• Rifampin
• Barbiturates
• Hypericum perforatum (St. John's wort)