OBJECTIVES:

• Compare cisplatin, etoposide, radiotherapy, and docetaxel with or without gefitinib, in terms of improving overall survival and progression-free survival, in patients with unresectable stage III non-small cell lung cancer.
• Determine the toxicity profile of gefitinib in these patients.

OUTLINE: This is a randomized, double-blind, multicenter study. Patients are stratified according to performance status (0 vs 1), stage (stage IIIA vs IIIB), measurability of lesion (measurable vs nonmeasurable), and histologic subtype (squamous vs nonsquamous).

Patients receive induction therapy comprising cisplatin IV over 1 hour on days 1, 8, 29, and 36 and etoposide IV over 1 hour on days 1-5 and 29-33. Beginning within 24 hours after starting chemotherapy, patients receive concurrent induction radiotherapy 5 days a week for 5 weeks and then boost radiotherapy 5 days a week for 1.5 weeks.

Beginning approximately 4-8 weeks after completion of chemoradiotherapy, patients with stable or responding disease receive consolidation therapy comprising docetaxel IV over 1 hour on day 1. Treatment repeats every 21 days for 3 courses.

Patients with stable or responding disease are randomized to one of two treatment arms for maintenance therapy. Patients begin maintenance therapy approximately 4-7 weeks after completion of consolidation therapy.

• Arm I: Patients receive oral gefitinib daily.
• Arm II: Patients receive oral placebo daily. In both arms, maintenance therapy continues for a maximum of 5 years in the absence of disease progression or unacceptable toxicity.

Patients are followed every 6 months for 5 years and then annually for 5 years.

PROJECTED ACCRUAL: A total of 840 patients will be accrued for this study within 3.5 years.

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed newly diagnosed single, primary bronchogenic non-small cell lung cancer (NSCLC)

  • Adenocarcinoma
  • Non-lobar and non-diffuse bronchoalveolar cell carcinoma
  • Large cell carcinoma
  • Squamous cell carcinoma

• Unresectable stage IIIA disease

  • Histologically or cytologically confirmed N2 status
  • Multiple and/or bulky mediastinal lymph nodes on CT scan or x-ray
  • Ineligible for induction chemotherapy or chemoradiotherapy followed by surgical resection
  • Ineligible for or refused participation in SWOG-9336 OR

• Stage IIIB disease

  • Pathologically or radiographically documented positive N3 nodes

    • No positive supraclavicular or scalene lymph nodes with disease extending up into the cervical region OR

  • Any documented T4 lesions invading the mediastinum, heart, great vessels, trachea, esophagus, vertebral body, or carina

    • Mediastinal involvement without organ involvement allowed if soft tissue mass extends directly into the mediastinum
    • Radiographic criteria for involvement of main pulmonary artery allowed if mediastinal soft tissue mass is present

• Single primary parenchymal lesion

  • No other lesions on same or opposite sides of the lung
  • No metastatic disease involving the contralateral chest, liver, or adrenals by CT scan of upper abdomen

• No malignant pleural or pericardial effusions

  • Pleural effusions visible only on CT scan or too small to tap allowed
• Measurable or evaluable disease by CT scan, MRI, x-ray, or physical exam
• No brain metastases

PATIENT CHARACTERISTICS:

Age:

• Not specified

Performance status:

• Zubrod 0-1

Life expectancy:

• Not specified

Hematopoietic:

• WBC at least 3,000/mm^3
• Absolute neutrophil count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic:

• Not specified

Renal:

• Creatinine clearance at least 50 mL/min

Pulmonary:

• FEV_1 at least 2.0 L OR
• FEV_1 less than 2.0 L if predicted FEV_1 of the contralateral lung is greater than 800 mL by quantitative split function testing

Other:

• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
• No other concurrent non-cancer-related illness that would preclude study therapy
• Not pregnant or nursing
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• No concurrent colony-stimulating factors during induction therapy

Chemotherapy:

• See Disease Characteristics
• No prior chemotherapy for NSCLC

Endocrine therapy:

• Not specified

Radiotherapy:

• See Disease Characteristics
• No prior radiotherapy for NSCLC

Surgery:

• No prior surgical resection of NSCLC
• Prior exploratory thoracotomy, mediastinoscopy, excisional biopsy, or similar diagnostic or staging surgery allowed