Bevacizumab and Docetaxel in Treating Older Patients With Stage III-IV Non-Small Cell Lung Cancer

Inclusion Criteria

• Patients, who are ≥ 75years, must have histologically or cytologically proven stage III/IV NSCLC, excluding squamous cell histology (patients with tumors with mixed cell histologies will be allowed if the squamous cell component is less than 50%) and who have never received chemotherapy for advanced NSCLC. Patients with squamous cell histology will be allowed if the primary tumor has been resected. Patients who have received adjuvant therapy, which did not include docetaxel or avastin, will be allowed if the adjuvant therapy was completed more than 1 year prior to the detection of recurrent NSCLC. Stage III patients will be eligible if they are not considered candidates for concurrent chemotherapy and radiation.
• Patients may have measurable or evaluable disease.
• Life expectancy of greater than 12 weeks.
• ECOG performance status < 2 (Karnofsky > 60%).
• Patients should undergo a brain MRI/CT scan within 4 weeks of study enrollment to evaluate for brain metastases.

• Patients must have adequate organ and marrow function as defined below:

  • leukocytes > 3,000/mcL
  • absolute neutrophil count > 1,500/mcL
  • platelets > 100,000/mcL
  • total bilirubin < 1.5 X institutional upper limit of normal
  • AST(SGOT)/ALT(SGPT)< 2.5 X institutional upper limit of normal < 5 X institutional upper limit of normal if patients has liver metastases
  • creatinine < 1.5 X of normal institutional limits
  • Cardiac function - MUGA scan or Echocardiogram- Left ventricular function should be > institutional normal limit
• Ability to understand and the willingness to sign a written informed consent document.
• Registered with the clinical trials office of the Karmanos Cancer Center/Wayne State University

Exclusion Criteria

• Patients with evidence of cavitation in the tumor.
• Patients with mixed histology will be allowed as long as the biopsy has less than 50% squamous cell histology.
• Patients who have had radiotherapy within 7 days of starting therapy on this study. Patients should have recovered to grade 1 or less from any adverse effects of the radiation.
• Patients with active brain metastases should be excluded. Patients with treated brain metastases will be allowed on the trial
• Patients cannot start on therapy on this trial < 7 days after completion of treatment for the brain metastases. Patient can be registered on the trial within 7 days of completing treatment for brain metastases.
• Brain scan should not have evidence of hemorrhage in the brain
• Patients should have stable or declining dose of steroids.
• Patients with craniotomy will not be able to start therapy for at least 3 months after craniotomy.
• Patients with resting blood pressure (BP) consistently > 140/90mm of Hg. Patients whose BP is controlled (< 140 mm of Hg systolic and < 90mm of Hg diastolic) after adjusting, starting or increasing the medications will be eligible.
• Patients with Urine Protein: Creatinine ratio > 1.0 at screening and/or Patients with > 1+ protein in the urine. Patients with urine protein > 1+ can be eligible if they undergo 24 hours urine collection and the urine protein is ≤ 1gin 24 hours.
• Patients with significant hemorrhage (> 30 mL bleeding/episode in previous 3 months) or hemoptysis that is > 5mL fresh blood in one episode in the previous 3 months.
• Evidence of bleeding diathesis or coagulopathy.
• Current or recent (within 10 days of enrollment) use of aspirin ≥ 325 mg/day or chronic use of Non-Steroidal Anti-inflammatory Drugs (NSAIDS).
• Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to start of therapy or anticipation of need for major surgical procedure during the course of the study. Core biopsy or other minor procedure, excluding placement of a vascular access device within 7 days prior to start of therapy.
• History of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 6 months prior to study enrollment.
• Serious non-healing wound, ulcer, or bone fracture.
• Patients may not be receiving any other investigational agents nor have participated in a trial involving an investigational agent within 30 days of starting therapy on this trial. Patient should have recovered to grade 1 or less from any adverse effects from any prior therapy excluding alopecia.
• Patients with history of other active malignancies. If patient has other cancers such as PSA only (without clinical or radiographic evidence) prostate cancer the patient can still be considered for this protocol if in the clinical judgment of the treating physician NSCLC is the most important malignancy and that the other malignancy will not impact patient's overall survival.
• Patients with history of myocardial infarction or cerebrovascular episode within 1 year of starting therapy on this study.
• Significant vascular disease such as aortic aneurysm, aortic dissection and symptomatic peripheral vascular disease.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, NYHA class II or greater congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Known hypersensitivity to any component of Avastin.