Erlotinib With or Without Hydroxychloroquine in Chemo-Naive Advanced NSCLC and (EGFR) Mutations

- Because no one knows which of the study options are best, participants will be
randomized into of the study groups: Group A (erlotinib) or Group B (erlotinib and HCQ).
Study treatment will be divided into time periods called cycles. Each study treatment
cycle is 28 days.

- Erlotinib (Group A and Group B) will be taken orally once a day. Hydroxychloroquine
(Group B) will be taken orally once a day after taking erlotinib.

- The following tests and procedures will be performed day 1 of each cycle: physical
examination, performance status assessment, questions about any symptoms or side
effects, blood for routine tests. The following procedures will be performed at certain
study visits: Research blood tests (cycle 1, cycle 2, then every other even cycle); eye
exam (cycle 4, cycle 7, and then every 3 months); assessment of the tumor with CT or MRI
scan (done at the end of even cycles.

Inclusion Criteria:

- Pathologically confirmed diagnosis of non-small cell lung cancer

- Stage IV disease by the American Joint Committee on Cancer/IASLC 7th edition proposed
edition staging criteria

- An EGFR sensitizing mutation must be detected in tumor tissue. Specifically, patients
harboring the most common mutations, deletions in exon 19 or the L858R mutation in
exon 21 are eligible. Presence of the known resistance mutation T790M as detected by
direct tumor sequencing is not allowed. Other rare EGFR mutations may be eligible
after discussion with the overall principal investigator

- Age equal to or greater than 18 years

- Measurable disease by RECIST criteria, defined as the presence of at least one lesion
that can be accurately measured in at least one dimension (longest diameter to be
recorded) as 10mm or greater with spiral CT scan

- ECOG Performance status of 0, 1 or 2

- Since prior radiation or surgery, 14 days or more must have elapsed before starting
protocol treatment

- No prior treatment with erlotinib, gefitinib, or other small molecule EGFR-TKIs. Prior
treatment in the adjuvant setting is allowed if at least 1 year has elapsed since TKI
course.

- Adequate organ function as outlined in the protocol

- Patients must undergo a screening eye exam to obtain approval for HCQ treatment, which
establishes the absence of baseline conditions include macular degeneration, visual
field changes, other retinal disease, and cataracts that interfere with required
funduscopic examinations

- No G6PD deficiency, as HCQ may cause hemolysis in patients with G6DP

Exclusion Criteria:

- Symptomatic CNS metastases or newly diagnosed CNS metastases that have not yet been
definitively treated with radiation and/or surgery. Note that patients with a history
of CNS metastases or cord compression are allowed if they have been definitively
treated and are clinically stable. Maintenance steroids are allowed but maintenance
seizure medication with an EIAED is not allowed

- Prior radiation therapy inclusive of all identified target lesions. Note that prior
palliative radiation to bony disease, CNS disease, or a limited thoracic area is
allowed, provided that there is measurable disease outside the field and radiation is
completed at least two weeks prior to starting treatment and the patient has fully
recovered from all side effects

- Current use of hydroxychloroquine for any reason

- Known hypersensitivity to chloroquine, hydroxychloroquine, or any closely related
drug: erlotinib, gefitinib, or any closely related drug

- Patients who are pregnant or breastfeeding. Female subjects of childbearing potential
and male subjects must practice acceptable methods of birth control

- Any evidence of clinically active interstitial lung disease. Note that patients with
chronic, stable radiographic changes who are asymptomatic are eligible

- Invasive malignancies within the past 3 years except for adequately treated carcinoma
of the cervix, basal or squamous cell carcinomas of the skin

- Evidence of any other significant clinical disorder or laboratory finding that makes
it undesirable for the patient to participate in the study, including a prior
diagnosis of porphyria or non-light-sensitive psoriasis, as HCQ can significantly
exacerbate both of these conditions

- Use of any non-FDA approved or investigational agent in 30 days or less of enrolling
onto the trial, or failure to recover from the side effects of any of these agents

- Penicillamine use for Wilson's disease or any other indication, as concomitant use
with HCQ can increase toxicity to penicillamine

- Life expectancy of less than 12 weeks