Cetuximab and Bevacizumab as First-Line Therapy Followed By Combination Chemotherapy and Bevacizumab With or Without Cetuximab as Second-Line Therapy in Treating Patients With Stage IV Colorectal Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed stage IV colorectal cancer
• Measurable disease, defined as at least one lesion whose longest diameter can be accurately measured as ≥ 2.0 cm by conventional techniques OR ≥ 1.0 cm by spiral CT scan
• Must not be a candidate for neoadjuvant therapy
• No CNS or brain metastases

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Life expectancy ≥ 12 weeks
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 10.0 g/dL
• Total bilirubin < 1.5 times upper limit of normal (ULN)
• Alkaline phosphatase ≤ 3 times ULN
• AST ≤ 3 times ULN
• Creatinine ≤ 1.5 x times ULN
• Proteinuria < 1+ by urinalysis OR proteinuria < 1 g by 24-hour urine collection
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• English-speaking patients must have the ability to complete questionnaires by themselves or with assistance
• Must be willing to provide blood and tissue samples for research purposes
• No history of hypertensive crisis or hypertensive encephalopathy
• No blood pressure > 150/100 mm Hg
• No New York Heart Association (NYHA) class II-IV congestive heart failure
• No myocardial infarction or unstable angina within the past 6 months
• No stroke or transient ischemic attack within the past 6 months
• No clinically significant vascular disease (e.g., aortic aneurysm or aortic dissection)
• No clinically significant peripheral vascular disease
• No evidence of bleeding diathesis or coagulopathy
• No significant traumatic injury within the past 28 days
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No serious nonhealing wound, ulcer, or bone fracture

PRIOR CONCURRENT THERAPY:

• No prior nonsurgical treatment for stage IV disease

  • Adjuvant therapy allowed if completed > 6 months prior to study registration
• More than 4 weeks since prior and no concurrent or planned participation in another experimental drug study
• No prior therapy that specifically and directly targets the EGFR pathway
• No prior monoclonal antibody therapy
• More than 28 days since prior major surgery or open biopsy

• More than 7 days since prior minor surgery, such as fine-needle aspirations or core biopsies

  • Placement of a vascular access device does not have to meet this criterion
• No concurrent major surgery