Intervention: Antroquinonol
Trial phase: Phase 2
SMILES: COC1=C(OC)[C@H](O)[C@H](C/C=C(\C)CC/C=C(\C)CCC=C(C)C)[C@@H](C)C1=O
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 31
Group description: patients will receive one 12 week cycle of antroquinonol 200 mg t.i.d. or until disease progression, unacceptable toxicity, non compliance or withdrawal of consent by the patient, or the investigator decides to discontinue treatment, whichever comes first.
Eligibility criteria:
Inclusion Criteria:

Cytologically or histologically confirmed non squamous NSCLC Stage IV (including pleural effusion).
Radiologically confirmed disease progression following two previous lines of anti-cancer therapy, one of which should be a platinum based regimen, OR the patient has refused treatment with approved treatment modalities
At least one radiologically measurable target lesion per RECIST version 1.1
Fresh or archival biopsy tissue available to determine tumor mutation status
Written informed consent that is consistent with International Conference on Harmonisation Tripartite Guideline on Good Clinical Practice guidelines
Patient or legally acceptable representative has granted written informed consent before any study specific procedures (including special Screening tests) are performed
Eastern Cooperative Oncology Group (ECOG) performance score of 0, 1 or 2
Hemoglobin ≥ 9.0 g/dL; platelets ≥ 100 x 109/L; absolute neutrophil count ≥ 1.5 x 109/L without the use of hematopoietic growth factors
Bilirubin and creatinine less than 2 × upper limit of normal (ULN) for the institution
Albumin ≥ 2.5 mg/dL
Aspartate aminotransferase and alanine aminotransferase less than 5 × ULN for the institution
Prothrombin time less than 1.5 × ULN for the institution
Potassium, magnesium and phosphorus within the normal range for the institution (supplementation is permissible)
Recovery to Grade 1 or baseline of any toxicities due to prior treatments, excluding alopecia

Exclusion Criteria:

Chemo-, hormone- or immunotherapy, within 4 weeks or within less than four half lives of the date of first administration of study drug and/or persistence of toxicities of prior anti-cancer therapies which are deemed to be clinically relevant
Radiotherapy within the past 2 weeks prior to date of first administration of study drug
Previous treatment with an histone deacetylase inhibitor or an epidermal growth factor receptor inhibitor within at least 4 weeks of the date of first administration of study drug
Treatment with any drug(s) known to be an inhibitor or inducer of cytochrome P450 (CYP)2C19, CYP3A4, CYP2C8, and CYP2E1, within 14 days of the date of first administration of study drug
Brain metastases, which are symptomatic; patients with treated, brain metastases are eligible with stable brain disease for at least 4 weeks without the requirement for steroids or anti epileptic therapy
Inability to swallow oral medications or a recent acute gastrointestinal disorder with diarrhea e.g., Cohn's disease, malabsorption, or Common Terminology Criteria for Adverse Event (CTCAE) Grade > 2 diarrhea of any etiology at baseline
Other malignancies diagnosed within the past five years (other than curatively treated cervical cancer in situ), non melanoma skin cancer, superficial bladder tumors Ta (non invasive tumor) and TIS (carcinoma in situ)
Patients with any serious active infection (i.e., requiring an intravenous antibiotic, antifungal, or antiviral agent)
Patients with known human immunodeficiency virus, active hepatitis B or active hepatitis C
Patients who have any other life threatening illness or organ system dysfunction, which in the opinion of the investigator, would either compromise patient safety or interfere with the evaluation of the safety of the study drug
Known or suspected substance abuse or alcohol abuse
Pregnancy or breast feeding
History of clinically significant or uncontrolled cardiac disease, including congestive heart failure, angina, myocardial infarction, arrhythmia, including New York Heart Association functional classification of three