Bevacizumab or Pemetrexed Disodium Alone or In Combination After Induction Therapy in Treating Patients With Advanced Non-Squamous Non-Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Cytologically or histologically confirmed non-small cell lung cancer (NSCLC)

  • Predominant non-squamous histology

    • NSCLC not otherwise specified allowed
    • Mixed tumors are categorized by the predominant cell type

• Must meet 1 of the following criteria:

  • Stage IV disease including M1a or M1b stages or recurrent disease
  • Stage IIIB (T4NX) disease with ipsilateral lung lobe allowed provided patients are not candidates for combined chemotherapy or radiotherapy
• Measurable or non-measurable disease as defined by RECIST criteria
• Patient must have an overall stable or better response after 4 courses of induction therapy
• No cavitary lesions in the lungs
• Patients with brain metastasis must have received local therapy to the brain and have no evidence of progression in the brain for at least 2 weeks from the time of completion of local therapy, prior to registration

PATIENT CHARACTERISTICS:

• ECOG performance status 0-1
• Leukocytes ≥ 3,000/mm^3
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Total bilirubin ≤ institutional upper limit of normal (ULN)
• AST and ALT ≤ 3 times ULN
• Creatinine ≤ institutional ULN OR creatinine clearance ≥ 60 mL/min
• Urine protein:urine dipstick ≤ 0-1+ (if > 1+, urine protein creatinine ratio must be < 1)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must agree to abstain from sexual intercourse or to use adequate contraceptive methods during and for at least 6 months after completion of study therapy
• No prior malignancy within the past 3 years except superficial melanoma, basal cell carcinoma, or carcinoma in situ
• No major hemoptysis within the past 4 weeks

• No uncontrolled intercurrent illness including, but not limited to, any of the following:

  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Serious cardiac arrhythmia
  • Psychiatric illness and/or social situations that would limit compliance with study requirements
• Patients with hypertension must be adequately controlled (BP < 150/100 mm Hg) with appropriate anti-hypertensive therapy or diet
• No history of arterial thrombotic events or major bleeding within the past 12 months
• No significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within the past 6 months
• No significant traumatic injury in the past 3 months
• No clinically significant cardiovascular disease
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No history of serious non-healing wounds, ulcers, or bone fractures

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 12 months since prior adjuvant chemotherapy
• At least 2 weeks since prior radiotherapy

• Patients must not have had any major surgery such as thoracotomy, laparotomy, craniotomy, or significant traumatic injury within 6 weeks prior to registration

  • Biopsy procedures and chest tube insertion are not considered major surgery for the purpose of this protocol
• More than 7 days since a core biopsy
• Concurrent therapeutic anti-coagulation allowed
• No prior systemic chemotherapy for advanced stage lung cancer

• No prior paclitaxel, pemetrexed disodium, or bevacizumab

  • Prior carboplatin allowed provided it was given as part of adjuvant chemotherapy
• No concurrent anti-retroviral therapy in patients with HIV infection