Phase II Trial of Chronic Oral ZD1839 (Iressa®) (NSC-715055) in Both Previously-Untreated and Previously-Treated Patients With Selected Stage IIIB and IV Bronchioloalveolar Carcinoma (BAC)

Inclusion Criteria:

- Patients must have a biopsy-proven, incompletely resected or unresectable
bronchioloalveolar carcinoma, with pathology tissue available for central review and
staining for EGFR and other molecular variables; fine needle aspirates, bronchial
brushings or washings are not permitted for diagnosis; patients must have either
selected stage IIIB due to cytology-confirmed malignant pleural effusion, or stage IV
disease; tumors may be multi-focal or diffuse

- Patients must have evidence of disease by CT scan of the chest; the pre-study CT scan
of the chest must include the liver and adrenal glands or be accompanied by an
abdominal CT scan in which they are visualized; all x-rays/scans to assess measurable
disease must have performed within 28 days prior to registration; all other required
tests to assess non-measurable disease must have been performed within 42 days prior
to registration

- The institution must plan to submit all pathology materials (i.e., H&E stained slide
from each block, plus 10 unstained slide from one block) within 30 days after
registration

- All patients must have a Zubrod performance status of 0-2

- Patients must not have received prior treatment with biologic therapies that target
EGFR; patients may not be currently receiving or planning to receive any other
treatment directed at the BAC

- Prior biologic therapy, chemotherapy and radiotherapy are allowed, provided that
at least four weeks have elapsed since last treatment with these modalities and
the patient's disease has been assessed since completing previous treatment;
disease must be present outside of areas of previous radiation therapy

- Prior surgery is allowed, provided that the patient has had sufficient recovery
time from surgery, as determined by the enrolling physician

- Patients must not have gastrointestinal tract disease resulting in an inability to
take oral medication or a requirement for IV alimentation; patients must not have had
prior surgical procedures affecting absorption

- Serum bilirubin =< 1.5 x the institutional upper limit of normal

- SGOT or SGPT =< 2.5 x the institutional upper limit of normal (IULN) (if liver
metastases are present; SGOT/SGPT =< 5 IULN allowed)

- Alkaline phosphatase =< 2.5 x IULN (if bone metastases are present, alkaline
phosphatase =< 5 x IULN is allowed); abnormalities in alkaline phosphatase levels
should be appropriately followed to document the possibility of bone or hepatic
metastases

- ANC >= 1,500/uL

- WBC >= 3,000/uL

- Platelet count >= 100,000/uL

- Institution must have receive IRB approval for S9925; patients must be offered
participating in S9925 (the Lung Cancer Specimen Repository); optional submissions of
buccal brushings for EGFR determination will be done via the Lung Cancer Specimen
Repository; patients must be registered separately to S9925 to receive credit for
buccal brushing submission

- Patient with known brain metastases are ineligible for this clinical trial; if there
are any abnormal findings on neurological examination suspicious for brain
metastases, a CT or MRI should be performed within 42 days prior to registration

- NOTE: a baseline slit lamp examination is NOT required; however, patients with eye
symptoms (eye pain, tearing, redness, vision problems) should be evaluated by an
ophthalmologist/optometrist prior to registration and the results documented on the
S0126 Toxicity and Dosage Form

- Patient must not have corneal inflammation or infection

- Patients requiring agents that induce CYP3A4 are excluded from the study, due to the
ability of these agents to significantly reduce plasma concentrations of ZD1839
potentially below the range likely to be biologically active if taken concurrently
with ZD1839 at the dose employed in the study; at the present time, agents known to
induce CYP3A4 include the antibiotics nafcillin and rifampin, the anticonvulsants
carbamazepine, phenobarbital, and phenytoin, as well as St. John's wort

- Patients must not have uncontrolled intercurrent illness including, but not limited
to, ongoing or active infection, symptomatic congestive heart failure, unstable
angina pectoris, cardiac arrhythmia or psychiatric illness/social situations that
would limit compliance with study requirements

- No other prior malignancy is allowed except to the following: adequately treated
basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
stage I or II cancer from which the patient is currently in complete remission, or
any other cancer from which the patient has been disease-free for five years

- Pregnant or nursing women are not eligible to participate in this trial; women/men of
reproductive potential must have agreed to use an effective contraceptive method

- All patients must be informed of the investigational nature of this study and must
sign and give written informed consent in accordance with institutional and federal
guidelines

- At the time of patient registration, the treating institution's name and ID number
must be provided to the Data Operations Center in Seattle in order to ensure that the
current (within 365 days) date of institutional review board approval for this study
has been entered into the data base