Second-Line Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Metastatic Colorectal Cancer Who Have Received First-Line Chemotherapy and Bevacizumab (BEBYP)

This is an interventional treatment trial for Colorectal Cancer focused on measuring adenocarcinoma of the colon, adenocarcinoma of the rectum, recurrent colon cancer, recurrent rectal cancer, stage IV colon cancer, stage IV rectal cancer, stage III rectal cancer, stage III colon cancer Read More

DISEASE CHARACTERISTICS:

• Histologically confirmed colorectal adenocarcinoma

  • Metastatic or unresectable disease

• Progressive disease based on the following criteria:

  • Progression during or after first-line chemotherapy for metastatic disease, including any of the following:

    • Fluoropyrimidine-based monotherapy with bevacizumab
    • Fluoropyrimidine and irinotecan hydrochloride-based doublet with bevacizumab
    • Fluoropyrimidine and oxaliplatin-based doublet with bevacizumab
  • Progression after more than 3 months from the last administration of first-line chemotherapy for metastatic disease with a fluoropyrimidine, irinotecan hydrochloride, and oxaliplatin triplet (FOLFOXIRI) with bevacizumab to which the patient had previously responded
• Measurable disease, as assessed by RECIST criteria
• No prior or concurrent CNS metastasis

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Life expectancy > 3 months
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 9 g/dL
• INR ≤ 1.5 times upper limit of normal (ULN)
• aPTT ≤ 1.5 ULN
• Serum bilirubin ≤ 1.5 times ULN
• AST and ALT ≤ 2.5 times ULN (< 5 times ULN if liver metastases present)
• Alkaline phosphatase ≤ 2.5 times ULN (< 5 times ULN if liver metastases present)
• Serum creatinine ≤ 1.5 times ULN
• Proteinuria < 2+ OR protein ≤ 1g by 24-hour urine
• Not pregnant or nursing
• Fertile patients must use effective contraception
• No bowel obstruction or subobstruction
• No history of inflammatory enteropathy
• No prior extensive intestinal resection (i.e., > hemicolectomy or extensive small intestine resection with chronic diarrhea)
• No symptomatic peripheral neuropathy > grade 2
• No active uncontrolled infection
• No active disseminated intravascular coagulation
• No prior or concurrent malignancy, except for curatively treated basal cell and squamous cell carcinoma of the skin, or in situ carcinoma of the cervix

• No clinically significant cardiovascular disease, including any of the following:

  • Cerebrovascular accident within the past 6 months
  • Myocardial infarction within the past 6 months
  • Unstable angina
  • NYHA class II-IV chronic heart failure
  • Uncontrolled arrhythmia
• No uncontrolled hypertension
• No thromboembolic or hemorrhagic events within the past 6 months
• No evidence of bleeding diathesis or coagulopathy
• No serious, non healing wound/ulcer or serious bone fracture
• No significant traumatic injury within the past 28 days

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 6 weeks since prior radiotherapy
• At least 4 weeks since prior surgery
• No prior first-line chemotherapy for metastatic disease without bevacizumab
• No prior cetuximab or other investigational agents
• More than 28 days since prior open biopsy
• More than 28 days since prior and no concurrent major surgical procedure

• No concurrent therapeutic anticoagulation, antiplatelet agents, or NSAID with anti-platelet activity

  • Acetylsalicylic acid ≤ 325 mg/day allowed