Neoadjuvant Platinum-based Chemotherapy for Patients With Resectable , Non-small Cell Lung Cancer With Switch to Chemotherapy Alternative in Nonresponders (NEOSCAN)

Inclusion Criteria:

• Pathologic confirmation of NSCLC at MSKCC
• Stages IB, IIA, IIB, IIIA or IIIB NSCLC
• Primary tumor must measure ≥ 2 cm on CT imaging (per PERCIST guidelines)
• Primary tumor must be FDG-avid with an SUVmax >4.5 (to be consistent with PERCIST guidelines)
• Patients must be candidates for resection with curative intent
• Age ≥ 18 years
• Karnofsky performance status ≥ 70%
• Normal bone marrow function
• leukocytes ≥ 3,000/μl
• absolute neutrophil count ≥ 1,500/μl
• platelets ≥100,000/μl
• hemoglobin ≥9gm/dl.
• Adequate hepatic function
• Total bilirubin ≤1.5 x ULN
• AST ≤ 1.5 x UNL, ALT ≤ 1.5 x ULN
• Alkaline phosphatase ≤ 1.5x ULN
• Women of childbearing age must have a negative pregnancy test
• Men and women of childbearing potential must be willing to use effective contraception while on treatment and for at least 3 months thereafter
• Patients must have the ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

• Patients must not be receiving any other investigational agents
• History of myocardial infarction or unstable angina within the past 12 months Patients with peripheral neuropathy > grade 1
• Other serious illness or medical condition including unstable cardiac disease requiring treatment, history of significant neurologic or psychiatric disorders (including psychotic disorders, dementia, or seizures), or active uncontrolled infection.
• Patients with diabetes mellitus requiring insulin therapy (per PERCIST guidelines)
• Patients with third space fluid which cannot be adequately controlled with drainage
• Women who are pregnant or breast-feeding
• Psychiatric illness or social situation that would limit compliance with study requirements
• Patients with known HIV infection requiring antiretroviral medications and those with AIDS

Selection of Pemetrexed versus Gemcitabine: Patients treated with pemetrexed must meet all of the following criteria:

• Non-squamous histology
• Adequate renal function with calculated creatinine clearance ≥45 ml/min by Cockcroft and Gault equation using parameters of age, weight in kilograms (kg), and baseline serum creatinine in mg/dl.
• Patients must have the ability to interrupt non-steroidal anti-inflammatory drugs (NSAIDs) 2 days before (5 days for long-acting NSAIDs), the day of, and 2 days following administration of pemetrexed
• Patients must have the ability to take folic acid, Vitamin B12, and dexamethasone according to protocol

Selection of Carboplatin versus Cisplatin: Patients may be treated with carboplatin instead of cisplatin if they meet any one of the following criteria:

• Baseline subjective hearing deficit, even if it does not require a hearing aid or intervention, or interfere with activities of daily living (CTCAE grade 2 or higher)
• Baseline renal insufficiency ≤ 60 ml/min as calculated by the equation of Cockcroft and Gault using the patient's age, weight (kg), and serum creatinine (mg/dl).
• Congestive heart failure with New York Heart Association functional classification > II, characterized by fatigue, dyspnea or other symptoms which limit activities of daily life.
• Patient refuses to take cisplatin