Mesothelioma Related Clinical Trials:
A Double Blind, Placebo Controlled Randomized Phase II Trial Of Gemcitabine And Cisplatin With Or Without The VEGF Inhibitor Bevacizumab (NSC #704865) In Patients With Malignant Mesotheloma

RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the ability of cancer cells to grow and spread. Others find cancer cells and help kill them or deliver cancer-killing substances to them. It is not yet known if combination chemotherapy works better with or without bevacizumab in treating malignant mesothelioma.

PURPOSE: This randomized phase II trial is to see if combination chemotherapy works better with or without bevacizumab in treating patients who have malignant mesothelioma.

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed malignant pleural or peritoneal mesothelioma that is not amenable to curative surgery
  • Epithelial, sarcomatoid, or mixed subtype
  • Evidence of gross unresectability, including, but not limited to, the following conditions:
    • Direct extension into the chest wall
    • Mediastinal or hilar lymphadenopathy
    • Pulmonary or cardiac function that is inadequate to tolerate resection
    • Sarcomatoid or mixed histology
• Pleural mesothelioma must be stage II or greater using the International Mesothelioma Interest Group staging system
• Measurable disease outside prior irradiation port
  • At least 20 mm by conventional techniques OR at least 10 mm by spiral CT scan
  • Pleural effusions and ascites are not considered measurable lesions
  • Site in pleura, lung, liver, or retroperitoneum that can be assessed by MRI for evaluation of blood flow
• No obvious tumor involvement of major vessels by CT scan
• No known brain metastases

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• ECOG 0-1

Life expectancy:

• More than 3 months

Hematopoietic:

• WBC at least 3,000/mm^3
• Absolute neutrophil count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3
• No history of bleeding diathesis

Hepatic:

• Bilirubin normal
• AST/ALT no greater than 2.5 times upper limit of normal
• INR no greater than 1.5

Renal:

• Creatinine no greater than 1.5 mg/dL OR
• Creatinine clearance at least 60 mL/min
• If 1+ or greater proteinuria on dipstick, then must have less than 500 mg of protein/24-hour urine collection
• No significant renal impairment

Cardiovascular:

• See Disease Characteristics
• No history deep vein thrombosis
• No myocardial ischemia or infarction within the past 6 months
• No uncompensated coronary artery disease within the past 6 months
• No uncontrolled hypertension
• No symptomatic congestive heart failure
• No unstable angina pectoris within the past 6 months
• No cardiac arrhythmia
• No transient ischemic attack within the past 6 months
• No cerebrovascular accident within the past 6 months
• No other arterial thromboembolic event within the past 6 months
• No clinically significant peripheral artery disease

Pulmonary:

• See Disease Characteristics
• No history of pulmonary embolism

Other:

• No prior allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab or other study agents
• No other active malignancy within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
• No ongoing or active infection
• No other concurrent uncontrolled illness that would preclude study participation
• No psychiatric illness or social situations that would preclude compliance
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• No growth factors for 24 hours before, during, or for 24 hours after cytotoxic chemotherapy

Chemotherapy:

• See Biologic therapy
• Prior intrapleural cytotoxic agents (including bleomycin) allowed
• No prior systemic cytotoxic chemotherapy

Endocrine therapy:

• Not specified

Radiotherapy:

• See Disease Characteristics
• At least 4 weeks since prior radiotherapy and recovered

Surgery:

• See Disease Characteristics
• At least 6 weeks since prior major surgery

Other:

• At least 30 days since prior investigational drug
• No other concurrent investigational or commercial agents or therapies
• No concurrent combination antiretroviral therapy for HIV-positive patients