Cisplatin + Etoposide +/- Concurrent ZD6474 in Previously Untreated Extensive Stage Small Cell Lung Cancer

OUTLINE: This is a multi-center study.

Arm A:

Cisplatin 60mg/m2 Day 1 + Etoposide 120mg/m2 Day 1,2,3 + Placebo oral daily given
continuously for the duration of the study

Arm B:

Cisplatin 60mg/m2 Day 1 + Etoposide 120mg/m2 Day 1,2,3 + ZD6474 100mg oral daily given
continuously for the duration of the study

For both arms, PE and toxicity evaluation prior to each cycle and disease assessment by
imaging every 2 cycles. Patients with non-PD and acceptable toxicity will continue protocol
therapy; patients with progressive disease or excessive toxicity will be taken off
treatment. Cycles will be repeated every 21 days up to a total of 4 cycles.

ECOG Performance Status of 0 or 1

Life Expectancy: Not specified

Hematopoietic:

- Platelets > 100K/mm3

- Absolute neutrophil count (ANC) > 1.5K/mm3

Hepatic:

- Bilirubin < 1.5 x ULN

- Aspartate aminotransferase (AST) < 2.5 x ULN or < 5 x ULN if judged by the investigator
to be related to liver metastases

- Alkaline phosphatase < 2.5 x ULN or < 5 x ULN if judged by the investigator to be
related to liver metastases

Renal:

- Serum creatinine < 1.5 x ULN or Calculated creatinine clearance of > 45 cc/min using
the Cockcroft-Gault formula

Cardiovascular:

- No clinically significant cardiac event such as myocardial infarction; New York Heart
Association (NYHA) classification of heart disease >2 (see SPM) within 3 months prior
to registration for protocol therapy

- No presence of cardiac disease that, in the opinion of the Investigator, increases the
risk of ventricular arrhythmia.

- No history of arrhythmia (multifocal premature ventricular contractions (PVCs),
bigeminy, trigeminy, ventricular tachycardia, or uncontrolled atrial fibrillation)
which is symptomatic or requires treatment (CTCAE grade 3) or asymptomatic sustained
ventricular tachycardia. Atrial fibrillation, controlled on medication is permitted.

Inclusion Criteria:

- Histological or cytological proof of chemotherapy-naïve, extensive, small cell lung
cancer.

- Measurable disease according to RECIST and obtained by imaging within 28 days prior
to being registered for protocol therapy.

- Written informed consent and HIPAA authorization for release of personal health
information.

- Age 18 years or older at the time of consent.

- Potassium ≥4.0 mmol/L and <5.5mmol/L (supplementation is allowed).

- Calcium within normal range (supplementation is allowed).

- Magnesium within normal range (supplementation is allowed).

Exclusion Criteria:

- No prior EGFR inhibitor or antiangiogenic agent allowed.

- No prior hormonal therapy.

- No symptomatic brain metastasis.

- No clinically significant infections as judged by the treating investigator.

- No evidence of severe or uncontrolled other systemic disease or any concurrent
condition which in the Investigator's opinion makes it undesirable for the subject to
participate in the trial or which would jeopardize compliance with the protocol.

- No previous history of QTc prolongation as a result of medication that required
discontinuation of that medication.

- No congenital long QT syndrome or known 1st degree relative with unexplained sudden
death under 40 years of age.

- No presence of left bundle branch block (LBBB.)

- No QTc with Bazett's correction that is unmeasurable, or ≥480 msec on screening ECG
obtained within 7 days prior to registration for protocol therapy. If a subject has
QTc ≥480 msec on screening ECG, the screen ECG may be repeated twice (at least 24
hours apart). The average QTc from the three screening ECGs must be <480 msec in
order for the subject to be eligible for the study.

- No concomitant (within 14 days prior to registration for and during protocol therapy)
medication associated with Torsades de Pointes or cause QTc prolongation, is allowed.
Medications that prolong QT, but are not strictly associated with Torsades, are
allowed if medically necessary and will require increased ECG and electrolyte
monitoring.

- No uncontrolled hypertension (systolic blood pressure greater than 160 mm Hg or
diastolic blood pressure greater than 100 mm Hg).

- No currently active diarrhea that may affect the ability to absorb ZD6474.

- No prior malignancy is allowed except for adequately treated basal cell or squamous
cell skin cancer, in situ cervical cancer, Gleason < grade 7 prostate cancers, or
other cancer for which the subject has been disease-free for at least 5 years.

- Major surgery must be completed greater than 28 days prior to registration for
protocol therapy and healed surgical incision is required.

- No concomitant (within 14 days prior to registration for and during protocol therapy)
medications that are potent inducers (rifampicin, rifabutin, phenytoin,
carbamazepine, phenobarbital and St. John's Wort) of CYP3A4 function.

- Females of childbearing potential and males must be willing to use an effective
method of contraception (hormonal or barrier method of birth control; abstinence)
from the time consent is signed until 8 weeks after treatment discontinuation.

- Females of childbearing potential must have a negative pregnancy test within 7 days
prior to being registered for protocol therapy.

- Females must not be breastfeeding.