Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed squamous cell non-small cell lung cancer
(NSCLC)

- Squamous histology mixed with other NSCLC component (e.g. adenosquamous) allowed

- No mixed histology with small cell component

- Stage IV disease

- Candidate for palliative chemotherapy

- Measurable disease, defined as ≥ 1 lesion whose longest diameter can be accurately
measured as ≥ 2.0 cm by chest X-ray OR as ≥ 1.0 cm by CT scan, CT component of a
PET/CT scan, or MRI

- If the sole site of disease was previously irradiated, there must be evidence of
disease progression at that site

- No symptomatic, untreated, or uncontrolled CNS metastases

- Concurrent enrollment on NCCTG-N0392 required

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Life expectancy ≥ 12 weeks

- ANC ≥ 1,500/μL

- Platelet count ≥ 100,000/μL

- Hemoglobin ≥ 9 g/dL

- Total bilirubin normal (< 3.0 mg/dL for patients with Gilbert syndrome)

- ALT and AST ≤ 2.5 times upper limit of normal (ULN)

- Alkaline phosphatase ≤ 5 times ULN

- Creatinine clearance ≤ 1.2 times ULN OR calculated creatinine clearance ≥ 60 mL/min

- Fasting glucose < 120 mg/dL

- HbA1c ≤ 7%

- INR < 1.5 OR PT/PTT normal (patients receiving anticoagulation therapy with an agent
such as warfarin or prophylactic-dose heparin are eligible provided the patient meets
the above criteria at the patient's stable dose of anticoagulants)

- QTc < 450 msec and no conduction abnormalities (e.g., heart block) on EKG

- Isolated premature ventricular or atrial conduction beats allowed

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Willing and able to comply with study

- Willing to return to NCCTG participating center for follow-up

- Willing to provide blood samples as required by study

- Able to complete questionnaire(s) alone or with assistance

- No clinically significant infection

- No significant traumatic injury within the past 4 weeks

- No symptomatic, untreated, or uncontrolled seizure disorder

- No uncontrolled diabetes mellitus, defined as fasting blood glucose ≥ 120 mg/dL on 2
consecutive measurements (taken ≤ 2 weeks apart) or by patient's clinical history

- No other uncontrolled illness including, but not limited to, any of the following:

- Ongoing or active infection

- Significant pulmonary symptoms at baseline due to disease

- Symptomatic congestive heart failure

- Unstable angina pectoris

- Cardiac arrhythmia

- Psychiatric illness/social situation that would limit compliance with study
requirements

- No second primary malignancy, except for any of the following:

- Carcinoma in situ of the cervix

- Nonmelanomatous skin cancer

- Other malignancy that was diagnosed and definitively treated ≥ 5 years ago with
no subsequent evidence of recurrence

- History of low-grade (Gleason score ≤ 6) localized prostate cancer, even if
diagnosed within the past 5 years

- Stage I breast cancer that was treated within the past 5 years

- No HIV-positivity and no history of chronic hepatitis B or C (regardless of viral
load)

- No evidence or history of bleeding diathesis or coagulopathy

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior chemotherapy for advanced lung cancer, except neoadjuvant therapy, adjuvant
therapy, or chemoradiotherapy for lung cancer administered > 12 months ago

- More than 12 months since prior gemcitabine hydrochloride, cisplatin, or carboplatin

- More than 12 months since prior immunotherapy or biologic therapy

- At least 1 week since prior gamma knife radiosurgery for brain metastases or
palliative radiotherapy for skeletal metastases and recovered

- At least 2 weeks since prior whole-brain radiotherapy for CNS metastases and
recovered

- More than 2 weeks since other prior radiotherapy

- No prior radiotherapy to ≥ 25% of bone marrow

- More than 2 weeks since prior minor surgery*

- More than 4 weeks since prior major surgery (e.g., laparotomy)*

- No other concurrent anticancer drugs or therapy

- No concurrent therapeutic anticoagulation

- Prophylactic anticoagulation (i.e., low-dose warfarin) of venous or arterial
access devices allowed provided the requirements for PT, INR, or PTT are met

- Concurrent radiotherapy for symptom palliation allowed

- Concurrent megestrol acetate for appetite allowed NOTE: *Insertion of a vascular
access device is not considered major or minor surgery