Erlotinib Hydrochloride With or Without Cixutumumab in Treating Patients With Stage III or Stage IV Non-Small Cell Lung Cancer

PRIMARY OBJECTIVES: I. To determine a tolerable dose of IMC-A12 (cixutumumab) in combination with erlotinib (erlotinib hydrochloride) in the target NSCLC population to be administered in the randomized phase II study section. II. To determine the difference in PFS between the anti-IGF-1R monoclonal antibody IMC-A12 in combination with erlotinib compared to erlotinib alone in the target NSCLC population. SECONDARY OBJECTIVES: I. To evaluate the safety, tolerability, and adverse event profile of IMC-A12 in combination with erlotinib in patients with advanced non-small cell lung cancer. II. To describe preliminary evidence of clinical activity of the combination of IMC-A12 and erlotinib. III. To determine the difference in overall response rate (ORR) between the two treatment arms. IV. To determine the response duration in patients who achieve an objective response in either study arm. V. To describe the response rate, time to disease progression, and response duration in the population who cross over to the combination arm after disease progression with single agent erlotinib therapy. TERTIARY OBJECTIVES: I. To explore the prognostic/predictive significance of the immunohistochemical, mutational, and cytogenetic profiles from archived tumor tissue of key elements of the EGFR, IGF-1R and other relevant signaling pathways in relationship to clinical benefit from treated individuals in both Part A and Part B sections of the study. II. To explore the prognostic/predictive significance of serum circulating markers (ligands and binding proteins) and serum proteomic profiles pre-treatment and at progression in both Part A and Part B sections of the study. III. To explore the impact of SNPs in germline and tumor derived DNA on toxicity and anti-cancer activity within both Part A and Part B sections of the study. IV. To explore the impact of SNPs in germline DNA on erlotinib pharmacokinetics within both Part A and Part B sections of the study. OUTLINE: This is a multicenter study that includes a single-arm safety evaluation phase I followed by a randomized phase II study. Initially, patients are enrolled in the safety evaluation phase. If ≤ 2 of 10 patients experience a dose-limiting toxicity, then the study may proceed to the randomized phase. Safety evaluation phase I: Patients receive cixutumumab intravenously (IV) over 1 hour on days 1, 8, 15, and 22 and erlotinib hydrochloride orally (PO) once daily on days 1-28. Courses repeat every 28 days until disease progression or unacceptable toxicity. Randomized phase II: Patients are stratified according to performance status, history of smoking (never vs ex vs current), stage of disease (IIIA vs IIIB without malignant effusion vs IIIB with malignant effusion vs IV), EGFR mutation (present vs absent vs not known), and disease histology (squamous vs non-squamous). Patients are randomized to 1 of 2 treatment arms. ARM 1: Patients receive erlotinib hydrochloride PO once daily on days 1-21. Patients with documented disease progression may cross over and receive treatment on arm II. ARM II: Patients receive erlotinib hydrochloride PO as in arm I and cixutumumab IV over 1 hour on days 1, 8, and 15. Patients receive treatment in both arms as in the safety evaluation portion. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Archived tissue and blood samples are collected periodically for pharmacokinetic analysis of erlotinib hydrochloride; pharmacogenomic analysis of EGRF, IGF1R, and CYP3A4/5 mutations; IHC and FISH analysis of IGF1R, EGFR, cMET, ras, Akt1, and EMT; proteomic analysis of serum ligand/binding proteins (i.e., IGF1, IGF2, IGFBPs, EGF, HRG, and TGF-α) using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF); mutational status analysis of EGFR and related pathway proteins; and RT-PCR analysis. After completion of study therapy, patients are followed for 4 weeks.