Avastin/Docetaxel/Carboplatin in Non-Small Cell Lung Cancer

• • Assessment of overall survival
• • Assessment of disease control rate (complete response + partial response + stable disease)
• • Evaluation of the safety and toxicity profile of this triple-agent regimen
• • To correlate the above primary and secondary objectives with biomarkers and immunohistochemistry from tissue samples (optional)

The goal of this clinical research study is to evaluate the effectiveness of Avastin® in combination with docetaxel and carboplatin in the treatment of lung cancer. The safety of this combination will also be studied.

Avastin® is a humanized monoclonal antibody that binds to vascular endothelial growth factor (VEGF). VEGF plays an important role in the growth of both normal and abnormal blood vessels. Avastin® is designed to prevent or slow down the growth of cancer cells by blocking the effects of VEGF.

Docetaxel and carboplatin are standard chemotherapy drugs that have been approved by the FDA for the treatment of NSCLC. Docetaxel and carboplatin are designed to work by stopping the division of cancer cells.

If you are found to be eligible, you will begin receiving Avastin®, docetaxel, and carboplatin. Avastin®, carboplatin, and docetaxel will be given by vein once every 3 weeks. The first dose of Avastin® will be given over 90 minutes. The second dose of Avastin® will be given over 60 minutes. All other doses of Avastin® will be given over 30 minutes. Carboplatin and docetaxel will always be given over 30 minutes. They will be given on the same day every 3 weeks (1 cycle). You may receive up to 6 cycles of treatment. You will receive standard premedication with dexamethasone to help decrease the risk of side effects. Dexamethasone will be taken before you receive your docetaxel infusion.

During the study, you will have blood tests (about 2 teaspoons) every 3 weeks to look at your blood counts. These samples will be used only for routine lab tests. You will be seen by a physician every 3 weeks and given a physical exam. Your blood pressure will be monitored, and you will be asked about any side effects you are experiencing. A performance status evaluation will also be done. In addition, you will have a urine test every 2 cycles of treatment.

After 2 cycles of treatment (6 weeks), you will have a chest x-ray and computerized tomography (CT) or magnetic resonance imaging (MRI) scan to evaluate the status of the disease. These will be repeated every 2 cycles. Your continued participation in this study depends on how your cancer responds to the study drugs. Your doctor may decide to take you off this study if you experience significant side effects or your medical condition worsens. You may continue receiving bevacizumab for as long as your cancer responds to study treatment.

You will be followed-up on by phone or at routine clinic visits for at least 12 months to monitor your condition and disease status.

This is an investigational study. Avastin® has been approved by the FDA for the treatment of colorectal cancer. Docetaxel and carboplatin are FDA approved and commercially available. The use of these drugs together in this study is experimental. A total of 50 patients will take part in this study. All participants will be enrolled at M. D. Anderson.

• Drug: Bevacizumab (Avastin)
  15 mg/kg intravenously (IV) every 3 weeks
  Other Names:

  • Anti-VEGF monoclonal antibody
  • rhuMAb-VEGF
• Drug: Carboplatin
  AUC 6 IV every 3 weeks
  Other Name: Paraplatin®
• Drug: Docetaxel
  75 mg/m2 IV every 3 weeks
  Other Name: Taxotere

Inclusion Criteria:

1. Men and women, at least 18 years old, with histologically confirmed, advanced stage IIIB or IV NSCLC for whom no curative options exist and for whom docetaxel and carboplatin is a reasonable treatment option;
2. At least 1 target lesion that is unidimensionally measurable as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) and has not been previously irradiated;
3. Eastern Cooperative Oncology Group Performance Status of 0 or 1, (determined within 2 weeks prior to receiving study medication;
4. Ability to understand and adhere to the protocol requirements, and give informed consent
5. Use of effective means of contraception (men and women) in subjects of child-bearing potential. Child-bearing potential is defined as follows: A woman of childbearing potential is a sexually mature woman who has not undergone a hysterectomy or who has not been naturally postmenopausal for at least 12 consecutive months (i.e., who has had menses at any time in the preceding 12 consecutive months).

Exclusion Criteria:

1. Patients who have had docetaxel in nonradiosensitizing therapy
2. Patients who have received prior full dose systemic chemotherapy for NSCLC (ie neoadjuvant, adjuvant, or metastatic) within the last 6 months.
3. ECOG status of 2 or greater
4. Screening clinical laboratory values:*ANC of <1,500/µL *Platelet count of <75,000/µL * INR >/= 1.5 *T bilirubin elevation above normal (MDACC upper normal limit is 1.0 mg/dL) *Serum creatinine of >2.0 mg/dL *Hemoglobin of <9 mg/dL (may be transfused or receive epoetin alfa [e.g., Epogen®] to maintain or exceed this level) *The pt is ineligible if: 1.alk phos>5xULN; 2.AST or ALT >5xULN; 3.alk phos >1xULN but </= 2.5xULN AND AST or ALT >1.5xULN but </=5xULN;4.alk phos >2.5xULN but </=5xULN AND AST or ALT > 1xULN but</= 1.5xULN; 5.alk phos >2.5xULN but</=5xULN AND AST or ALT >1.5xULN but </=5xULN
5. Inability to comply with study and/or follow-up procedures
6. History of other disease, active infection, metabolic dysfunction , physical examination finding, or clinical laboratory finding which is uncontrolled requiring medical intervention giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect the interpretation of the results of the study or render the subject at high risk from treatment complications.
7. Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study other than a bevacizumab cancer study
8. Prior exposure to anti-VEGF therapy
9. Blood pressure of > 140/90 mmHg as documented in two consecutive blood pressure readings within 4 hours
10. Any prior history of hypertensive crisis or hypertensive encephalopathy
11. New York Heart Association (NYHA) Grade II or greater congestive heart failure
12. History of myocardial infarction or unstable angina within 6 months
13. History of stroke or transient ischemic attack within 6 months
14. Significant vascular disease (e.g., aortic aneurysm, aortic dissection)
15. Evidence of bleeding diathesis or coagulopathy
16. Presence of central nervous system or brain metastases at any time
17. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 0, anticipation of need for major surgical procedure during the course of the study
18. Minor surgical procedures, fine needle aspirations or core biopsies within 7 days prior to Day 0
19. Pregnant (positive pregnancy test) or lactating
20. Proteinuria at screening as demonstrated by either: Urine protein:creatinine (UPC) ratio > 1.0 at screening OR Urine dipstick for proteinuria > 2+ (patients discovered to have > 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24 hour urine collection and must demonstrate < 1g of protein in 24 hours to be eligible).
21. History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to Day 0
22. Serious, non-healing wound, ulcer, or bone fracture
23. Lung carcinoma of squamous cell histology or any histology in close proximity to a major vessel, cavitation.
24. History of hemoptysis (bright red blood of 1/2 teaspoon or more)
25. Full dose anticoagulation, chronic use of Aspirin (>325 mg/day) or NSAIDs
26. Inability to comply with study and/or follow-up procedures