Triplet Combination First Line Treatment in Non Small Cell Lung Cancer (NSCLC)

Inclusion Criteria:

Signed informed consent obtained prior to initiation of any study-specific procedures
Histologically or cytologically confirmed diagnosis of non-squamous non small cell lung cancer (NSCLC), not amenable for radical resection, stage IIIB with pleural or pericardial effusion or stage IV, who has not received previous chemotherapy or other systemic treatment
At least one unidimensionally measurable lesion according to the Response Evaluation Criteria in Solid Tumors (RECIST)
Male or female patients aged at least 18 years
ECOG Performance Status (PS): 0-1
Life expectancy > 3 months
Prior local radiotherapy is allowed if it was completed ≥ 3 weeks prior to the first dose of the study medication
Concomitant palliative radiotherapy to an existing bone lesion for pain control is allowed
Prior surgery is allowed if it is performed at least 4 weeks prior to the first dose of study medication and patient should be fully recovered
Adequate organ function, including the following:
Bone marrow: white blood cell (WBC) count >= 4 x 109/L, absolute neutrophil count (ANC) >= 1.5 x 109/L, platelet count >= 100 x 109/L, hemoglobin >= 9 g/dL
Hepatic: Bilirubin ≤ 1.5 x the upper limit of normal (ULN), aspartate transaminases (AST/SGOT) and alanine transaminases (ALT/SGPT) ≤ 2.5 x ULN (or ≤ 5 x ULN if liver metastases are present), INR ≤ 1.5 x ULN, albumin >= 3.0 g/dL
Renal: Serum creatinine ≤ 1.5 mg/dL or creatinine clearance >= 45 mL/min (calculated according to the Cockroft and Gault formula)
Female patients of child-bearing potential must have a negative pregnancy test and be using at least one form of contraception as approved by the Investigator for 4 weeks prior to the study and 4 months after the last dose of study drug. For the purposes of this study, child-bearing potential is defined as: "All female patients unless they are post-menopausal for at least one year or are surgically sterile"
Male patients must use a form of barrier contraception approved by the Investigator during the study and for 4 months after the last dose of study drug
Ability to cooperate with the treatment and follow-up

Exclusion Criteria:

Radiation therapy to more than 30% of the bone marrow prior to entry into the study
Histology of pure bronchioloalveolar carcinoma or neuroendocrine features in the tumor sample
Previous treatment with chemotherapy, new biological therapies (small molecules, antibodies), immunotherapy
Absence of measurable lesions
An ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, symptomatic or poorly controlled cardiac arrhythmia, uncontrolled thrombotic or hemorrhagic disorder, or any other serious uncontrolled medical disorders in the opinion of the Investigator
Any previous history of another malignancy within 5 years of study entry (other than cured basal cell carcinoma of the skin or cured in-situ carcinoma of the cervix)
Presence of any significant central nervous system (CNS) or psychiatric disorder(s) that would hamper the patient's compliance
Evidence of peripheral neuropathy > grade 1 according to NCI-CTCAE Version 3
Treatment with any other investigational agent, or participation in another clinical trial within 28 days prior to study entry
Pregnant or breast-feeding patients or any patient with childbearing potential not using adequate contraception
Known HIV, HBV, HCV infection
Presence of symptomatic brain metastasis. Patients with brain metastases must:
Have stable neurologic status following local therapy (surgery or radiation) for at least 2 weeks after completion of the definitive therapy.
Be without neurologic dysfunction that would confound the evaluation of neurologic and other AEs
Inability or unwillingness to take folic acid, vitamin B12 or corticosteroids
Inability to interrupt aspirin or other nonsteroidal anti-inflammatory agents, other than aspirin dose ≤ 1.3 grams per day, for a 5-day period (8-day period for long-acting agents, such piroxicam)
Significant weight loss (>= 10% body weight during preceding 6 weeks)
Presence of clinically significant (by physical exam) third space fluid collections, e.g., ascites or pleural effusions that cannot be controlled by drainage or other procedures prior to study entry