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This combination is a biomodulatory therapy that was studied in the ModuLung trial (EUDRACT 2014-004095-31, NCT02852083), a phase II randomized trial for patients with non-small cell lung cancer (NSCLC) who failed first-line platinum-based chemotherapy. The therapy consists of treosulfan 250 mg twice daily, pioglitazone 45 mg once daily, and clarithromycin 250 mg twice daily, administered orally until disease progression or unacceptable toxicity. **Clarithromycin** is an antibiotic that affects inflammation, evidence suggests it controls tumor-associated inflammation and improves cachexia. **Pioglitazone** is a PPAR-alpha/gamma agonist approved for type 2 diabetes. PPAR-gamma activation has been proposed as a therapeutic strategy for NSCLC, affecting tumor cell growth and cell death. **Treosulfan** is an alkylating agent used at a "metronomic dose" in this combination.
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