Rationale: Pivanex is a histone deacetylase inhibitor that induces tumor differentiation and/or apoptosis. Pivanex has been well tolerated in clinical trials and has shown preliminary evidence of efficacy in patients with non-small cell lung cancer. Docetaxel is an approved drug for second-line treatment of non-small cell lung cancer. Preclinical studies indicate that the combination of Pivanex and docetaxel is synergistic. Purpose: This open-label randomized trial will evaluate whether combination therapy with Pivanex and docetaxel provides clinical benefit over docetaxel alone in patients with chemotherapy resistant non-small cell lung cancer. Objectives: * Compare the survival of patients with non-small cell lung cancer treated with combination therapy with Pivanex and docetaxel vs. docetaxel alone * Compare the time to disease progression, tumor responses, and safety profile of patients with non-small cell lung cancer treated with combination therapy with Pivanex and docetaxel vs. docetaxel alone Outline: This is a randomized, open-label, multicenter study in patients with non-small cell lung cancer who have previously been treated with no more than one prior platinum containing chemotherapy regimen. Patients are stratified by ECOG performance status (0-1 vs. 2), response to prior platinum based chemotherapy (progression vs. CR/PR/SD) and prior taxane therapy (yes vs. no). Patients are randomized to 1 of 2 treatment arms. * Arm A: Patients receive the combination of Pivanex intravenously on Days 1-3 and docetaxel intravenously on Day 4. Treatment repeats every 21 days until disease progression or treatment withdrawal. * Arm B: Patients receive docetaxel intravenously on Day 1. Treatment repeats every 21 days until disease progression or treatment withdrawal.
Inclusion Criteria: * Histologically or cytologically confirmed non-small cell lung cancer (NSCLC); Treatment with one prior platinum-based chemotherapy regimen (Eligible patients may include: 1. Patients previously treated with adjuvant or neoadjuvant chemotherapy (must be completed within 6 months prior to randomization) or 2. Patients who have received chemotherapy for advanced or metastatic lung cancer); * Recurrent or progressive NSCLC (local, distant, or both) following initial chemotherapy); * Measurable or non-measurable disease; * Males and females, age =\> 18 years; * Adequate renal function with creatinine =\> 1.5 mg/dl; * Adequate liver function with alkaline phosphatase =\> 2.5 X upper limit of normal, SGOT, and SGPT =\> 1.5 X upper limit of normal; and total bilirubin =\> upper limit of normal; * Adequate bone marrow function: platelets \> 100,000/mm3, hemoglobin =\> 9 g/dL, and absolute neutrophil count (ANC) =\> 1,500 cells/mm3; * Able to give informed consent; * Discontinuation of previous surgery, radiation therapy or cancer chemotherapy at least four weeks prior to randomization (six weeks if a prior nitrosourea or mitomycin C), with recovery from treatment-associated toxicity; * A predicted life expectancy of at least 12 weeks; and * ECOG performance status of 0, 1, or 2. Exclusion Criteria: * Receipt of more than one chemotherapy regimen for NSCLC; * A second malignancy within the last 5 years other than curatively treated carcinoma-in-situ or non-melanoma skin cancer; * Pregnant or lactating females (Females of childbearing potential must have a negative pregnancy test and all male and female patients of reproductive potential must agree to use adequate birth control); * Known HIV-positive patients; * Acute medical problems, such as ischemic heart or lung disease or uncontrolled systemic infection; * Patients with any underlying medical conditions or circumstance, which would contraindicate therapy with study treatment, affect compliance or impair evaluation of study endpoints; * Patients receiving investigational agents within 30 days of the screening visit; * Known allergy to reagents in the study; * Prior docetaxel therapy; * Symptomatic or untreated brain metastases (Patients with brain metastases are eligible if they are clinically and neurologically stable for \> 4 weeks since therapy (radiation therapy, radiosurgery/gamma knife; surgical resection) as determined by the investigator and either off corticosteroids or on a stable dose of corticosteroids).