Carboplatin, Pemetrexed Disodium, and Bevacizumab in Treating Patients With Stage IIIB, Stage IV, or Recurrent Non-Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically* or cytologically* confirmed non-small cell lung cancer

  • Any histology, except squamous cell carcinoma, allowed

    • Mixed tumors will be categorized by the predominant cell type unless small cell elements are present, in which case the patient is ineligible
  • No histology in close proximity to a major vessel or cavitation NOTE: *Histologic or cytologic elements may be established on metastatic tumor aspirates or biopsy

• Meets 1 of the following stage criteria:

  • Stage IIIB disease (with malignant pleural effusion)
  • Stage IV disease
  • Recurrent disease
• Measurable or non-measurable disease
• No known CNS metastases by CT scan or MRI

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count > 1,500/mm^3
• Platelet count > 100,000/mm^3
• No history of hemorrhagic disorders

Hepatic

• Bilirubin < 1.5 mg/dL
• AST and ALT < 5 times upper limit of normal
• INR < 1.5
• PTT normal

Renal

• Creatinine clearance ≥ 45 mL/min
• Urine protein:creatinine ≤ 1.0 by spot urinalysis

Cardiovascular

• No myocardial infarction within the past 6 months
• No New York Heart Association class II-IV congestive heart failure
• No unstable angina pectoris
• No serious cardiac arrhythmia requiring medication
• No stroke within the past 6 months
• No peripheral vascular disease ≥ grade 2

• No uncontrolled hypertension (i.e., blood pressure ≥ 150/100 mm Hg)

  • Patients with a history of hypertension allowed provided blood pressure is well controlled on a stable regimen of anti-hypertensive therapy
• No history of thrombotic disorders
• No other clinically significant cardiovascular disease

Pulmonary

• No history of gross hemoptysis, defined as bright red blood of a ½ teaspoon or more

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Must be willing and able to take daily oral folic acid, intermittent vitamin B_12 injections, and corticosteroid premedication
• No ongoing or active infection
• No serious, non-healing wound, ulcer, or bone fracture
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No psychiatric illness or social situation that would preclude study compliance

PRIOR CONCURRENT THERAPY:

Biologic therapy

• More than 3 weeks since prior immunotherapy

Chemotherapy

• No prior systemic chemotherapy

Endocrine therapy

• More than 3 weeks since prior hormonal therapy

Radiotherapy

• See Disease Characteristics
• More than 3 weeks since prior radiotherapy

Surgery

• More than 4 weeks since prior major surgery
• More than 1 week since prior minor surgery, fine needle aspiration, or core biopsy
• No concurrent major surgery

Other

• Recovered from all prior therapy
• More than 4 weeks since prior and no concurrent participation in another experimental drug study
• No aspirin or other nonsteroidal anti-inflammatory drug (NSAID) 2 days before and 2 days after each pemetrexed disodium infusion (5 days before and 2 days after each pemetrexed disodium infusion for NSAIDs with a long half-life [e.g., naproxen, rofecoxib, or celecoxib])

• No concurrent therapeutic anticoagulation

  • Concurrent prophylactic anticoagulation for venous access devices allowed provided requirements for INR and PTT are met

• No concurrent administration of any of the following:

  • Chronic daily treatment with aspirin (> 325 mg per day)

  • NSAIDs known to inhibit platelet function, including any of the following:

    • Dipyridamole
    • Ticlopidine
    • Clopidogrel
    • Cilostazol