Gemcitabine and Carboplatin Followed by Paclitaxel in Treating Patients With Stage III or Stage IV Non-Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed non-small lung cancer (NSCLC) of any of the following histologic types:

  • Squamous cell
  • Adenocarcinoma
  • Large cell carcinoma
  • Unspecified

• Evidence of at least 1 of the following criteria:

  • Newly diagnosed inoperable stage IIIB (pleural effusion) disease
  • Patients with stage III disease who are unable to undergo combined modality therapy
  • Stage IV disease
  • Recurrent non-small cell lung cancer regardless of site
  • Diagnosis based on sputum cytology acceptable if confirmed by an independent pathologic review

• Patients must have measurable or evaluable disease

  • Measurable or evaluable disease must be outside the previous radiation field or a new lesion must be present
• Patients with brain metastases are eligible, provided they are either asymptomatic (no neurological symptoms or signs, no evidence of midline shift), or controlled (i.e., after surgical resection or radiotherapy/radiosurgery), and off all steroid therapy for at least two weeks with no evidence of progression by symptoms or radiologic imaging

PATIENT CHARACTERISTICS:

• ECOG performance status of 2 or 3 OR HIV-positive OR underwent prior status post organ transplantation
• No active serious infection (except for HIV infection)
• No symptomatic, untreated malignant pericardial effusion
• No congestive heart failure
• No other serious underlying medical condition that would otherwise impair their ability to receive protocol treatment
• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm ^3
• Creatinine clearance ≥ 40 mL/min
• Creatinine ≤ 1.8 mg/dL
• Bilirubin < 1.5 mg/dL
• SGOT ≤ 2 times upper limit of normal
• Not pregnant or nursing
• Negative pregnancy test
• Males or females of reproductive potential may not participate unless they have agreed to use effective barrier contraceptive methods
• No prior malignancy within the past 5 years except for adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Prior chemotherapy is not allowed
• At least three weeks since prior radiotherapy and recovered from all toxicities
• At least three weeks must have elapsed from major surgery and recovered from all adverse effects of surgery
• No prior colony-stimulating factors or interferon

• No concurrent hormonal, biologic, or radiotherapy to measurable lesions

  • Patients may receive concurrent palliative radiotherapy to small-field nonmeasurable sites of disease (e.g., painful bony metastases)