Pemetrexed Disodium, Carboplatin, and Radiation Therapy With or Without Cetuximab in Treating Patients With Stage III Non-Small Cell Lung Cancer That Cannot Be Removed By Surgery

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC), including any of the following subtypes:

  • Squamous cell carcinoma
  • Adenocarcinoma (including bronchoalveolar cell carcinoma)
  • Large cell anaplastic carcinoma (including giant cell and clear cell carcinoma)

• Stage IIIA OR selected stage IIIB disease*

  • Any T, N2-3, M0 disease
  • T3, N1-3, M0 disease allowed provided disease is unresectable
  • T4, any N, M0 disease allowed provided T4 status cannot be determined due to malignant effusion
  • No T3, N0, M0 disease NOTE: *If the largest mediastinal lymph node is < 2 cm in diameter by CT scan, a biopsy confirmation of mediastinal nodal involvement is required
• Unresectable disease
• Contralateral mediastinal disease (N3) allowed provided all gross disease can be encompassed within the radiation field in accordance with the homogeneity criteria

• Measurable disease, defined as ≥ 1 one-dimensional measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan

  • The following are not considered measurable disease:

    • Bone lesions
    • Leptomeningeal disease
    • Ascites
    • Pleural or pericardial effusion
    • Abdominal masses not confirmed and followed by imaging techniques
    • Cystic lesions
    • Tumor lesions in a previously irradiated area

• No exudative, bloody, or cytologically positive malignant effusion

  • Transudate, cytologically negative, non-bloody pleural effusion allowed provided the tumor can be encompassed within a reasonable field of radiotherapy
  • Pleural effusion detectable by chest CT scan but not by chest x-ray that is too small to tap
  • New pleural effusion appearing after thoracotomy or other invasive thoracic procedure allowed
• No atelectasis of the entire lung
• No direct invasion of the vertebral body
• No scalene, supraclavicular, or contralateral hilar node involvement
• No distant metastases (M1) by fludeoxyglucose F18 positron emission tomography

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3

Hepatic

• Bilirubin < 1.5 times upper limit of normal (ULN)
• AST and ALT < 3 times ULN
• Alkaline phosphatase < 3 times ULN

Renal

• Creatinine clearance ≥ 45 mL/min

Cardiovascular

• No symptomatic congestive heart failure
• No unstable angina pectoris
• No cardiac arrhythmia

Other

• Not pregnant or nursing
• Weight loss ≤ 10% within the past 3 months
• No other active* malignancy except nonmelanoma skin cancer
• No ongoing or active infection
• No other uncontrolled illness
• No history of hypersensitivity to carboplatin, pemetrexed disodium, or a monoclonal antibody NOTE: *Malignancy is not considered active if the patient has completed treatment and has < 30% risk of relapse

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No concurrent filgrastim (G-CSF), pegfilgrastim, or sargramostim (GM-CSF) during thoracic radiotherapy or as prophylaxis for myelosuppression

Chemotherapy

• No prior chemotherapy for NSCLC
• No other concurrent chemotherapy

Endocrine therapy

• No concurrent hormonal therapy except megestrol for appetite stimulation or dexamethasone to prevent rash from pemetrexed disodium

Radiotherapy

• No prior radiotherapy to the chest
• No concurrent palliative radiotherapy
• No concurrent intensity modulated radiotherapy

Surgery

• See Disease Characteristics
• At least 2 weeks since prior formal exploratory thoracotomy

Other

• No prior therapy that directly targets the epidermal growth factor receptor pathway
• No concurrent combination antiretroviral therapy for HIV-positive patients