Phase II Trial of Preoperative Chemotherapy and Bevacizumab in Patients With Stage IB (>4 cm), II, or Select Stage III Non-Small Cell Lung Cancer
1. Age >=18 years.
2. Histologically-confirmed NSCLC (adenocarcinoma, large cell, and undifferentiated).
Patients with squamous histology are not eligible.
3. Life expectancy of at least 12 weeks.
4. Patients with the following stages of NSCLC:
- T2 N0 tumors: Limited to tumors >=4 cm.
- T1-2 N1 tumors.
- T3 N0-1 tumors (excluding superior sulcus tumors): Including tumors involving
the chest wall, proximal airway, or mediastinal pleura where preoperative RT is
- T1-2 N2 tumors: For patients with N2 disease involving 1 zone (Upper zone (R),
AP zone (L), subcarinal zone, or lower zone) and nodes <=2 cm in diameter.
- T4 N0-1 tumors (excluding superior sulcus tumors): T4 lesions, other than
malignant effusions where radiotherapy is not planned.
5. Patients with clinical N2 involvement must have histologic confirmation by
mediastinoscopy (or alternate biopsy procedure).
6. Tumors should be considered potentially resectable.
7. No evidence of extrathoracic metastatic disease.
8. Patients must have measurable disease by RECIST version 1.1 criteria.
9. Patients must be candidates (medically) for chemotherapy followed by surgical
10. Adequate recovery from recent surgery. At least 1 week must have elapsed from the
time of a minor surgery (with the exception of portacath or other central access
catheter placement); at least 4 weeks must have elapsed from the time of a major
11. Laboratory values as follows:
- Absolute neutrophil count (ANC) >=1500/µL
- Hemoglobin (Hgb) >=9 g/dL
- Platelets >=100,000/uL
- AST/SGOT and ALT/SGPT within normal limits (WNL)
- Total bilirubin within normal limits (WNL)
- Creatinine <=1.5 mg/dL
12. ECOG Performance Status grade 0 or 1.
13. Women of childbearing potential must have a negative serum or urine pregnancy test
performed within 7 days prior to start of treatment. Women of childbearing potential
or men with partners of childbearing potential must use effective birth control
measures during treatment. If a woman becomes pregnant or suspects she is pregnant
while participating in this study, she must agree to inform her treating physician
14. Patient must be accessible for treatment and follow-up.
15. Patients must be able to understand the investigational nature of this study and give
written informed consent prior to study entry.
1. Mixed small-cell and non-small cell histologies.
2. Pulmonary carcinoid tumors.
3. History of prior malignancy within 3 years, with the exception of non-melanoma skin
cancer or carcinoma in situ.
4. Peripheral neuropathy >= grade 1.
5. Patients receiving thrombolytic therapy within 10 days of starting study treatment
are ineligible. Therapeutic anticoagulation is allowed if the anticoagulant dosing is
6. History of acute myocardial infarction or unstable angina within 6 months prior to
Day 1 of study treatment.
7. History of or stroke or ischemic attack within 6 months prior to Day 1 of study
8. Inadequately controlled hypertension (defined as systolic blood pressure >150 mmHg
and/or diastolic blood pressure >100 mmHg) in spite of medical management.
9. New York Heart Association (NYHA) class II or greater congestive heart failure (CHF).
10. Patients with significant vascular disease (e.g., aortic aneurysm requiring surgical
repair, or recent peripheral arterial thrombosis) within 6 months prior to Day 1 of
11. Any prior history of hypertensive crisis or hypertensive encephalopathy.
12. Patients with hematemesis or hemoptysis (>=1/2 teaspoon of bright red blood per
episode) within 1 month prior to Day 1 of study treatment.
13. Proteinuria at screening, as demonstrated by either:
- Urine protein: creatinine (UPC) ratio >=1.0 (see Appendix A) at screening, or
- Urine dipstick for proteinuria >=2+ (patients discovered to have >=2+
proteinuria on dipstick analysis should undergo a 24-hour urine collection and
must have <=1g of protein in 24 hours to be eligible).
14. Patients with a serious non-healing wound, active ulcer, or untreated bone fracture.
15. Patients with evidence of bleeding diathesis or coagulopathy (in the absence of
16. History of abdominal fistula, gastrointestinal perforation, or intra-abdominal
abscess within 6 months prior to Day 1 of study treatment.
17. Women who are pregnant (positive pregnancy test) or lactating.
18. Use of any non-approved or investigational agent within 28 days of administration of
the first dose of study drug.
19. Patients may not receive any other investigational or anti-cancer treatments while
participating in this study.
20. Concurrent severe, intercurrent illness including, but not limited to, ongoing or
active infection, or psychiatric illness/social situations that would limit
compliance with study requirements.
21. History of hypersensitivity to active or inactive excipients of any component of
22. Inability to comply with study and/or follow-up procedures.