Pioglitazone Hydrochloride in Treating Patients With Stage IA-IIIA Non-small Cell Lung Cancer

PRIMARY OBJECTIVES:

I. To evaluate the mechanism(s) of action of pioglitazone as a candidate chemopreventive
agent for lung cancer by investigating the effects on Ki-67 defined in non-small cell lung
cancer (NSCLC) tumor tissue.

SECONDARY OBJECTIVES:

I. To determine the effects of pioglitazone on multiple markers listed below:

- Tumor tissue: caspase-3, cyclin D1, p21/Waf1, peroxisome proliferative activated
receptor, gamma (PPARγ), mucin 1 (MUC1).

- Premalignant tissue: Ki-67, caspase-3, PPARγ.

- Histologically normal tissue: Ki-67, PPARγ. II. To evaluate the toxicity and safety of
pioglitazone in this patient population.

III. To analyze the expression of serum markers that are affected by pioglitazone.

IV. To describe the effects of limited treatment with pioglitazone on tumor metabolic
activity as determined by FDG-PET (assessed before and after a minimum of 2 weeks of
treatment).

OUTLINE:

Patients receive pioglitazone hydrochloride orally (PO) once daily (QD) for 14-42 days.
Patients then undergo surgery.

Inclusion Criteria:

- Suspected or biopsy-proven NSCLC

- Willingness to provide biopsy tissue for correlative studies

- Candidate for pulmonary resection; must be able to schedule >= 14 days and =< 42 days
between registration and surgery to allow for treatment with pioglitazone

- Ability to understand and the willingness to sign a written informed consent document

- Ability and willingness to swallow oral tablets

- Ability and willingness to undergo two bronchoscopies (before treatment and at the
time of surgery)

- For those participants who are undergoing mediastinoscopy as part of their
standard-of-care, the pre-treatment bronchoscopy may be performed during the
mediastinoscopy; if the participant remains eligible for definitive surgical
resection after the mediastinoscopy, the participant may proceed to registration
and pioglitazone treatment

- Current or former smoker with a >= 10 pack-year smoking history

- Women of child-bearing potential and men who agree to use adequate contraception for
the duration of study participation; women must not be pregnant or lactating; women of
child-bearing potential (women considered not of childbearing potential if they are at
least two years postmenopausal and/or surgically sterile) must have used adequate
contraception (abstinence; barrier methods such as intrauterine device [IUD],
diaphragm with spermicidal gel, condom, or others; and hormonal methods such as birth
control pills or others) since her last menses prior to study entry; should a woman
become pregnant or suspect she is pregnant while participating in this study, she
should inform her study physician immediately

Exclusion Criteria:

- Receiving any other investigational agents

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to pioglitazone

- 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

- Pregnant or lactating woman

- Currently treated diabetes

- Participants with >= class II New York Heart Association (NYHA) congestive heart
failure or history of congestive heart failure

- Participants with >= grade 2 (moderate) edema

- Participants currently receiving an inhibitor of cytochrome P450 family 2, subfamily
C, polypeptide 8 (CYP2C8) (gemfibrozil, ketoconazole, quercetin, trimethoprim), or an
inducer of CYP2C8 (cortisol, dexamethasone, phenobarbital, rifampin), or cytochrome
P450 family 3, subfamily A, polypeptide 4 (CYP3A4) substrate

- Prior neoadjuvant therapy for NSCLC

- History of bladder cancer or in situ bladder cancer