Advanced stage lung cancer is generally treated with anti-cancer medication called chemotherapy. Most lung cancer is caused by cigarette smoking. However, some lung cancers develop in people who never smoked or who only smoked for a short period of time. This type of lung cancer may respond to a medication called erlotinib (Tarceva). Erlotinib is an anticancer pill that is approved by the Food and Drug Administration (FDA) for use in patients with advanced lung cancer. Unfortunately, erlotinib does not work for all patients or only works for a period of time. The doctors are trying to find ways to improve the effect of erlotinib by combining it with another anti-cancer medication.

Ascenta Therapeutics, Inc. has developed a drug called AT-101 as a potential treatment for cancer. AT-101 is an investigational drug. That means that AT-101 is not approved by the United States Food and Drug Administration (FDA) for general use. The FDA does permit its use in studies like this one to determine whether it is safe and effective.

This is the first study to examine the effects of AT-101 and erlotinib. It is hoped that by combining AT-101 with erlotinib, AT-101 may help erlotinib work better to shrink lung cancer. Studies that have been performed in the laboratory suggest that AT-101 in combination with erlotinib may be more effective at shrinking tumors than erlotinib alone.

Inclusion Criteria:

• Ability to understand and the willingness to sign a written informed consent form; the consent form must be signed by the patient prior to any study-specific procedures.
• Patients age ≥ 18 years with histologically confirmed wet Stage IIIB (with malignant pleural effusion) or Stage IV non-small cell lung cancer (metastatic or recurrent).
• Pathologic confirmation of non-small cell lung cancer at Memorial Sloan-Kettering Cancer Center.
• Presence of exon 19 or exon 21 EGFR activating mutation.
• No prior EGFR tyrosine kinase therapy.
• No prior systemic therapy for advanced NSCLC (Stage IIIB with malignant effusion or Stage IV)
• Karnofsky performance status > or = to 70% OR ECOG performance status ≤ 2.
• Measurable disease defined as greater than or equal to one known/suspected malignant lesion > or = to 1 cm measurable in two dimensions.
• Adequate hematologic, renal, and/or hepatic function: WBC > or = to 3,000/ul, hemoglobin > or = to 9.0 g/dl, platelet count > or = to 100,000/ul, total bilirubin ≤ 1.5 X UNL, AST ≤ 2.5 X UNL, and serum creatinine within 1.5 x the upper limit of normal (<1.95 at MSKCC) or calculated creatinine clearance > or = to 60 ml/min.
• Able to swallow and retain oral medication.
• Willingness and ability to comply with study procedures and follow-up examination.
• Four weeks since any major surgery, completion of radiation, or completion of all prior chemotherapy.
• Acute toxicities of any prior therapy must have resolved to < Grade 1 or baseline prior to starting study therapy.
• Effective contraception.

Exclusion Criteria:

• Prior treatment with gefitinib, erlotinib, or other EGFR tyrosine kinase inhibitor therapy.
• Concurrent cytotoxic or biological therapy.
• Known KRAS mutation.
• History within the past 6 months of myocardial infarction, cardiac stent placement, or intermittent ischemia with troponin leak.
• Active secondary malignancy or history of other malignancy within the last 3 years except non-melanoma skin cancer and in-situ carcinoma of the cervix.
• Active, serious comorbid medical conditions including severe infection, malnutrition, unstable angina, congestive heart failure (New York Heart Association Class III or IV), pulmonary fibrosis, or condition that would be felt by treating physician to preclude safe participation in the clinical trial.
• Patients with malabsorption syndrome or diseases significantly affecting the gastrointestinal tract including prior gastric resection or small bowel resection, inflammatory bowel disease, or partial or complete small bowel obstruction.
• Unstable brain or leptomeningeal metastases including patients who continue to require glucocorticoids for brain or leptomeningeal metastases.
• Women who are pregnant or breast-feeding.
• Inability/unwillingness to comply with protocol treatment or follow-up.