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

About this trial
This is an interventional treatment trial for Lung Cancer focused on measuring recurrent non-small cell lung cancer, stage IIIB non-small cell lung cancer, stage IV non-small cell lung cancer, adenocarcinoma of the lung, bronchoalveolar cell lung cancer, large cell lung cancer
Eligibility Criteria
Inclusion Criteria (Step 1 Induction Therapy):
- 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.
- 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
- At least 12 months since prior adjuvant chemotherapy
- At least 2 weeks since prior radiotherapy
- Prior carboplatin allowed provided it was given as part of adjuvant chemotherapy
- 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
- ECOG (Eastern Cooperative Oncology Group) performance status 0-1
- Leukocytes ≥ 3,000/mm^3
- Absolute neutrophil count ≥ 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)
- Measurable or non-measurable disease as defined by RECIST (Response Evaluation Criteria in Solid Tumours) criteria
- Patients with hypertension must be adequately controlled (BP < 150/100 mm Hg) with appropriate anti-hypertensive therapy or diet
- Concurrent therapeutic anti-coagulation allowed
- 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
Exclusion Criteria (Step 1 Induction Therapy):
- Prior malignancy within the past 3 years except superficial melanoma, basal cell carcinoma, or carcinoma in situ
- Prior systemic chemotherapy for advanced stage lung cancer
- Prior use of paclitaxel, pemetrexed disodium, or bevacizumab
- Major hemoptysis within the past 4 weeks
- Uncontrolled intercurrent illness including, but not limited to, active infection, symptomatic congestive heart failure, unstable angina pectoris, serious cardiac arrhythmia, psychiatric illness/social situations that would limit compliance with study requirements
- History of arterial thrombotic events or major bleeding within the past 12 months
- 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.
- Core biopsy within 7 days of registration
- Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within the past 6 months
- Clinically significant cardiovascular disease
- Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
- History of serious non-healing wounds, ulcers, or bone fractures
- Cavitary lesions in the lungs
- Pregnant or nursing
- Concurrent anti-retroviral therapy in patients with HIV infection
Inclusion Criteria (Step 2 Maintenance Therapy):
- Patient must have an overall stable or better response after 4 courses of induction therapy
- ECOG (Eastern Cooperative Oncology Group) performance status 0-1
- Patients must be registered to Step 2 within 6 weeks of the last day of chemotherapy administration on Step 1
- Acceptable bone marrow, renal and hepatic function within 2 weeks of registration
Sites / Locations
- Regional Medical Center
- Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital
- North Bay Cancer Center
- Todd Cancer Institute at Long Beach Memorial Medical Center
- Community Hospital of the Monterey Peninsula Comprehensive Cancer Center
- Veterans Affairs Medical Center - Palo Alto
- Feather River Hospital Cancer Center
- Sutter Cancer Center at Roseville Medical Center
- Sutter Cancer Center
- Salinas Valley Memorial Hospital
- Stanford Cancer Center
- Aurora Presbyterian Hospital
- Boulder Community Hospital
- Penrose Cancer Center at Penrose Hospital
- St. Anthony Central Hospital
- Kaiser Permanente - Denver
- Porter Adventist Hospital
- Presbyterian - St. Luke's Medical Center
- St. Joseph Hospital
- Rose Medical Center
- CCOP - Colorado Cancer Research Program
- Swedish Medical Center
- Poudre Valley Hospital
- Front Range Cancer Specialists
- North Colorado Medical Center
- Kaiser Permanente - Lafayette
- Littleton Adventist Hospital
- Sky Ridge Medical Center
- Hope Cancer Care Center at Longmont United Hospital
- McKee Medical Center
- Parker Adventist Hospital
- St. Mary - Corwin Regional Medical Center
- North Suburban Medical Center
- Exempla Lutheran Medical Center
- Praxair Cancer Center at Danbury Hospital
- Helen and Harry Gray Cancer Center at Hartford Hospital
- Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
- George Bray Cancer Center at the Hospital of Central Connecticut - New Britain Campus
- Kaiser Permanente at Capitol Hill Medical Center
- Sibley Memorial Hospital
- Veterans Affairs Medical Center - Washington, DC
- North Broward Medical Center
- Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital
- Broward General Medical Center Cancer Center
- Memorial Cancer Institute at Memorial Regional Hospital
- Ella Milbank Foshay Cancer Center at Jupiter Medical Center
- CCOP - Mount Sinai Medical Center
- Florida Hospital Cancer Institute at Florida Hospital Orlando
- Sacred Heart Cancer Center at Sacred Heart Hospital
- Sacred Heart Medical Oncology
- Cleveland Clinic Florida - Weston
- Phoebe Cancer Center at Phoebe Putney Memorial Hospital
- Winship Cancer Institute of Emory University
- Veterans Affairs Medical Center - Atlanta (Decatur)
- Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler
- Pearlman Comprehensive Cancer Center at South Georgia Medical Center
- Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center
- Mountain States Tumor Institute at St. Luke's Regional Medical Center
- Saint Luke's Mountain States Tumor Institute - Fruitland
- St. Joseph Regional Medical Center
- Mountain States Tumor Institute - Meridian
- Saint Luke's Mountain States Tumor Institute
- Mountain States Tumor Institute at St. Luke's
- Rush-Copley Cancer Care Center
- Robert H. Lurie Comprehensive Cancer Center at Northwestern University
- Hematology and Oncology Associates
- University of Illinois Cancer Center
- Veterans Affairs Medical Center - Chicago Westside Hospital
- Swedish Covenant Hospital
- Resurrection Medical Center
- Louis A. Weiss Memorial Hospital
- Saint Joseph Hospital
- Elmhurst Memorial Hospital
- St. Francis Hospital
- Leonard C. Ferguson Cancer Center
- Delnor Hospital - Geneva
- Kellogg Cancer Care Center
- Hinsdale Hematology Oncology Associates
- Joliet Oncology-Hematology Associates, Limited - West
- Provena St. Mary's Regional Cancer Center - Kankakee
- La Grange Memorial Hospital
- North Shore Oncology and Hematology Associates, Limited - Libertyville
- Cancer Care and Hematology Specialists of Chicagoland - Niles
- West Suburban Center for Cancer Care
- Swedish-American Regional Cancer Center
- Center for Cancer Care at OSF Saint Anthony Medical Center
- Hematology Oncology Associates - Skokie
- CCOP - Carle Cancer Center
- Central Dupage Cancer Center
- St. Francis Hospital and Health Centers - Beech Grove Campus
- Clarian Arnett Cancer Care
- Suniti Medical Corporation
- Saint Anthony Memorial Health Centers
- Reid Hospital & Health Care Services
- McFarland Clinic, PC
- Hematology Oncology Associates of the Quad Cities
- Iowa Blood and Cancer Care
- St. Luke's Hospital
- Cedar Rapids Oncology Associates
- Mercy Regional Cancer Center at Mercy Medical Center
- Medical Oncology and Hematology Associates - West Des Moines
- Mercy Cancer Center - West Lakes
- Heartland Oncology and Hematology
- CCOP - Iowa Oncology Research Association
- John Stoddard Cancer Center at Iowa Methodist Medical Center
- Medical Oncology and Hematology Associates at John Stoddard Cancer Center
- Medical Oncology and Hematology Associates at Mercy Cancer Center
- Mercy Cancer Center at Mercy Medical Center - Des Moines
- John Stoddard Cancer Center at Iowa Lutheran Hospital
- Mercy Cancer Center at Mercy Medical Center - North Iowa
- McCreery Cancer Center at Ottumwa Regional
- Siouxland Hematology-Oncology Associates, LLP
- Mercy Medical Center - Sioux City
- St. Luke's Regional Medical Center
- Covenant Cancer Treatment Center
- Methodist West Hospital
- Providence Medical Center
- Menorah Medical Center
- Saint Luke's Hospital - South
- CCOP - Kansas City
- Mitchell Memorial Cancer Center at Owensboro Medical Health System
- Mary Bird Perkins Cancer Center - Baton Rouge
- Ochsner Health Center - Bluebonnet
- Ochsner Health Center - Covington
- Louisiana State University Health Sciences Center - Monroe
- MBCCOP - LSU Health Sciences Center
- Medical Center of Louisiana - New Orleans
- New Orleans Cancer Institute at Memorial Medical Center
- CCOP - Ochsner
- Ochsner Cancer Institute at Ochsner Clinic Foundation
- Feist-Weiller Cancer Center at Louisiana State University Health Sciences
- Harold Alfond Center for Cancer Care
- CancerCare of Maine at Eastern Maine Medical Center
- Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
- Kaiser Permanente at Woodlawn Medical Center
- Regional Cancer Center at Western Maryland Health System - Sacred Heart Campus
- Frederick Memorial Hospital Regional Cancer Therapy Center
- Kaiser Permanente - Gaithersburg Medical Center
- Kaiser Permanente Mid-Atlantic Medical Group-Largo Medical Facility
- Peninsula Regional Medical Center
- Holy Cross Hospital
- Sturdy Memorial Hospital
- Addison Gilbert Hospital
- Jordan Hospital Club Cancer Center
- Baystate Regional Cancer Program at D'Amour Center for Cancer Care
- UMASS Memorial Cancer Center - University Campus
- Hickman Cancer Center at Bixby Medical Center
- Saint Joseph Mercy Cancer Center
- CCOP - Michigan Cancer Research Consortium
- Oakwood Cancer Center at Oakwood Hospital and Medical Center
- Green Bay Oncology, Limited - Escanaba
- Genesys Hurley Cancer Institute
- Hurley Medical Center
- Genesys Regional Medical Center
- Van Elslander Cancer Center at St. John Hospital and Medical Center
- Dickinson County Healthcare System
- Foote Memorial Hospital
- Borgess Medical Center
- West Michigan Cancer Center
- Bronson Methodist Hospital
- Sparrow Regional Cancer Center
- St. Mary Mercy Hospital
- Upper Michigan Cancer Center at Marquette General Hospital
- Community Cancer Center of Monroe
- Mercy Memorial Hospital - Monroe
- St. Joseph Mercy Oakland
- Mercy Regional Cancer Center at Mercy Hospital
- Seton Cancer Institute at Saint Mary's - Saginaw
- St. John Macomb Hospital
- MeritCare Bemidji
- St. Joseph's Medical Center
- Fairview Ridges Hospital
- Mercy and Unity Cancer Center at Mercy Hospital
- Duluth Clinic Cancer Center - Duluth
- CCOP - Duluth
- Miller - Dwan Medical Center
- Fairview Southdale Hospital
- Mercy and Unity Cancer Center at Unity Hospital
- Hutchinson Area Health Care
- Immanuel St. Joseph's
- HealthEast Cancer Care at St. John's Hospital
- Minnesota Oncology - Maplewood
- Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
- Hennepin County Medical Center - Minneapolis
- New Ulm Medical Center
- Humphrey Cancer Center at North Memorial Outpatient Center
- CCOP - Metro-Minnesota
- Park Nicollet Cancer Center
- Regions Hospital Cancer Care Center
- United Hospital
- St. Francis Cancer Center at St. Francis Medical Center
- Lakeview Hospital
- Ridgeview Medical Center
- Willmar Cancer Center at Rice Memorial Hospital
- Minnesota Oncology - Woodbury
- Regional Cancer Center at Singing River Hospital
- Central Care Cancer Center at Carrie J. Babb Cancer Center
- Skaggs Cancer Center at Skaggs Regional Medical Center
- Southeast Cancer Center
- Goldschmidt Cancer Center
- St. John's Regional Medical Center
- Saint Luke's Cancer Institute at Saint Luke's Hospital
- North Kansas City Hospital
- Heartland Hematology Oncology Associates, Incorporated
- Research Medical Center
- Saint Luke's East - Lee's Summit
- Parvin Radiation Oncology
- Mercy Clinic Cancer and Hematology - Rolla
- Phelps County Regional Medical Center
- Heartland Regional Medical Center
- Saint Joseph Oncology, Incorporated
- St. Anthony's Cancer Center
- Missouri Baptist Cancer Center
- CCOP - Cancer Research for the Ozarks
- St. John's Regional Health Center
- Hulston Cancer Center at Cox Medical Center South
- CCOP - Montana Cancer Consortium
- St. Vincent Healthcare Cancer Care Services
- Hematology-Oncology Centers of the Northern Rockies - Billings
- Billings Clinic - Downtown
- Bozeman Deaconess Cancer Center
- St. James Healthcare Cancer Care
- Great Falls Clinic - Main Facility
- Sletten Cancer Institute at Benefis Healthcare
- St. Peter's Hospital
- Glacier Oncology, PLLC
- Kalispell Medical Oncology at KRMC
- Kalispell Regional Medical Center
- Montana Cancer Specialists at Montana Cancer Center
- Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
- Good Samaritan Cancer Center at Good Samaritan Hospital
- Cancer Resource Center - Lincoln
- CCOP - Missouri Valley Cancer Consortium
- Immanuel Medical Center
- Alegant Health Cancer Center at Bergan Mercy Medical Center
- Lakeside Hospital
- Creighton University Medical Center
- Renown Institute for Cancer at Renown Regional Medical Center
- Seacoast Cancer Center at Wentworth - Douglass Hospital
- Oncology Center at St. Joseph Hospital
- Veterans Affairs Medical Center - East Orange
- Monmouth Medical Center
- Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton
- Carol G. Simon Cancer Center at Morristown Memorial Hospital
- UMDNJ University Hospital
- Newark Beth Israel Medical Center
- Frederick R. and Betty M. Smith Cancer Treatment Center
- Overlook Hospital
- Franklin & Edith Scarpa Regional Cancer Center at South Jersey Healthcare
- Fox Chase Virtua Health Cancer Program at Virtua West Jersey
- Albert Einstein Cancer Center at Albert Einstein College of Medicine
- Maimonides Cancer Center at Maimonides Medical Center
- Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett Hospital
- Charles R. Wood Cancer Center at Glens Falls Hospital
- Nalitt Cancer Institute at Staten Island University Hospital
- Stony Brook University Cancer Center
- Faxton Regional Cancer Center
- Dickstein Cancer Treatment Center at White Plains Hospital Center
- Randolph Hospital
- Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
- Presbyterian Cancer Center at Presbyterian Hospital
- Wayne Memorial Hospital, Incorporated
- Moses Cone Regional Cancer Center at Wesley Long Community Hospital
- Pardee Memorial Hospital
- Kinston Medical Specialists
- Annie Penn Cancer Center
- Rutherford Hospital
- Iredell Memorial Hospital
- Medcenter One Hospital Cancer Care Center
- Mid Dakota Clinic, PC
- St. Alexius Medical Center Cancer Center
- MeritCare Broadway
- Dakota Cancer Institute at Dakota Clinic - South University
- CCOP - MeritCare Hospital
- Roger Maris Cancer Center at MeritCare Hospital
- Altru Cancer Center at Altru Hospital
- Trinity CancerCare Center
- Cleveland Clinic Beachwood Family Health and Surgery Center
- Wood County Oncology Center
- Mercy Cancer Center at Mercy Medical Center
- Aultman Cancer Center at Aultman Hospital
- Case Comprehensive Cancer Center
- MetroHealth Cancer Care Center at MetroHealth Medical Center
- Cleveland Clinic Cancer Center at Fairview Hospital
- Cleveland Clinic Taussig Cancer Center
- Grandview Hospital
- Good Samaritan Hospital
- David L. Rike Cancer Center at Miami Valley Hospital
- Samaritan North Cancer Care Center
- CCOP - Dayton
- Community Cancer Center
- Hematology Oncology Center
- Blanchard Valley Medical Associates
- Middletown Regional Hospital
- Wayne Hospital
- Cleveland Clinic Cancer Center
- Charles F. Kettering Memorial Hospital
- St. Rita's Medical Center
- Lima Memorial Hospital
- Northwest Ohio Oncology Center
- Hillcrest Cancer Center at Hillcrest Hospital
- Southwest General Health Center
- UHHS Chagrin Highlands Medical Center
- St. Charles Mercy Hospital
- Toledo Clinic - Oregon
- Parma Community General Hospital
- North Coast Cancer Care, Incorporated
- Cleveland Clinic Foundation - Strongsville
- Flower Hospital Cancer Center
- Mercy Hospital of Tiffin
- Toledo Hospital
- St. Vincent Mercy Medical Center
- Medical University of Ohio Cancer Center
- CCOP - Toledo Community Hospital
- St. Anne Mercy Hospital
- Toledo Clinic, Incorporated - Main Clinic
- UVMC Cancer Care Center at Upper Valley Medical Center
- Fulton County Health Center
- UHHS Westlake Medical Center
- Cleveland Clinic - Wooster
- United States Air Force Medical Center - Wright-Patterson
- Ruth G. McMillan Cancer Center at Greene Memorial Hospital
- Cancer Care Associates - Norman
- Cancer Care Associates - Mercy Campus
- Natalie Warren Bryant Cancer Center at St. Francis Hospital
- Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
- Bryn Mawr Hospital
- Geisinger Cancer Institute at Geisinger Health
- Mercy Fitzgerald Hospital
- Ephrata Cancer Center at Ephrata Community Hospital
- Regional Cancer Center - Erie
- Fox Chase Cancer Center Buckingham
- Adams Cancer Center
- Cherry Tree Cancer Center
- PinnacleHealth Regional Cancer Center at Polyclinic Hospital
- Geisinger Hazleton Cancer Center
- Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center
- Lancaster General Hospital
- Lewistown Hospital
- Riddle Memorial Hospital Cancer Center
- Cancer Center of Paoli Memorial Hospital
- Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
- Fox Chase Cancer Center - Philadelphia
- Frankford Hospital Cancer Center - Torresdale Campus
- Albert Einstein Cancer Center
- Iris V. Henderson Cancer Center at Mercy Hospital of Philadelphia
- St. Joseph Medical Center
- McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center
- Guthrie Cancer Center at Guthrie Clinic Sayre
- Mercy Hospital Cancer Center - Scranton
- Hematology and Oncology Associates of Northeastern Pennsylvania
- Grand View Hospital
- Geisinger Medical Group - Scenery Park
- Mount Nittany Medical Center
- Chester County Hospital
- Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center
- Susquehanna Cancer Center at Divine Providence Hospital
- CCOP - Main Line Health
- Lankenau Cancer Center at Lankenau Hospital
- York Cancer Center at Apple Hill Medical Center
- AnMed Cancer Center
- Cancer Centers of the Carolinas - Easley
- Bon Secours St. Francis Health System
- Cancer Centers of the Carolinas - Faris Road
- Cancer Centers of the Carolinas - Grove Commons
- Greenville Hospital Cancer Center
- CCOP - Greenville
- Cancer Centers of the Carolinas - Greer Medical Oncology
- Cancer Centers of the Carolinas - Seneca
- CCOP - Upstate Carolina
- Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
- Cancer Centers of the Carolinas - Spartanburg
- Oncology Services of Aberdeen
- Rapid City Regional Hospital
- Avera Cancer Institute
- Sanford Cancer Center at Sanford USD Medical Center
- West Tennessee Cancer Center at Jackson-Madison County General Hospital
- Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center
- Vanderbilt-Ingram Cancer Center
- Hendrick Cancer Center
- Harrington Cancer Center
- M. D. Anderson Cancer Center at University of Texas
- Community Cancer Center at Rutland Regional Medical Center
- Fredericksburg Oncology, Incorporated
- Virginia Oncology Associates - Hampton
- Kaiser Permanente Tysons Corner Medical Center
- Southwest Virginia Regional Cancer Center at Wellmonth Health
- Virginia Commonwealth University Massey Cancer Center
- Auburn Regional Center for Cancer Care
- Overlake Cancer Center at Overlake Hospital Medical Center
- Providence Centralia Hospital
- Providence Regional Cancer Partnership
- St. Francis Hospital
- Cascade Cancer Center at Evergreen Hospital Medical Center
- Providence St. Peter Hospital Regional Cancer Center
- Good Samaritan Cancer Center
- CCOP - Virginia Mason Research Center
- Virginia Mason Medical Center
- Pacific Medical Center
- Rockwood Clinic Cancer Treatment Center
- Franciscan Cancer Center at St. Joseph Medical Center
- Allenmore Hospital
- CCOP - Northwest
- MultiCare Regional Cancer Center at Tacoma General Hospital
- St. Clare Hospital
- West Virginia University Health Sciences Center - Charleston
- Mary Babb Randolph Cancer Center at West Virginia University Hospitals
- Langlade Memorial Hospital
- Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
- Bellin Memorial Hospital
- Green Bay Oncology, Limited at St. Mary's Hospital
- St. Mary's Hospital Medical Center - Green Bay
- St. Vincent Hospital Regional Cancer Center
- Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center
- Mercy Regional Cancer Center
- Gundersen Lutheran Center for Cancer and Blood
- Holy Family Memorial Medical Center Cancer Care Center
- Bay Area Cancer Care Center at Bay Area Medical Center
- Vince Lombardi Cancer Clinic - Marinette
- Wheaton Franciscan Cancer Care - St. Joseph
- D.N. Greenwald Center
- Regional Cancer Center at Oconomowoc Memorial Hospital
- Green Bay Oncology, Limited - Oconto Falls
- Vince Lombardi Cancer Clinic - Oshkosh
- St. Nicholas Hospital
- Vince Lombardi Cancer Clinic - Sheboygan
- Green Bay Oncology, Limited - Sturgeon Bay
- Aurora Medical Center
- Vince Lombardi Cancer Clinic - Two Rivers
- Waukesha Memorial Hospital Regional Cancer Center
- University of Wisconcin Cancer Center at Aspirus Wausau Hospital
- Oncology Alliance, SC - Milwaukee - West
- Riverview UW Cancer Center at Riverview Hospital
- Rocky Mountain Oncology
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Experimental
Arm A (Induction then Maintenance with Bevacizumab)
Arm B (Induction then Maintenance with Pemetrexed)
Arm C (Induction then Maintenance with Bevacizumab & Pemetrexed)
Induction Therapy: Patients receive paclitaxel IV over 3 hours, carboplatin IV over 15-30 minutes, and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Maintenance Therapy: Patients achieving complete response, partial response or stable disease following induction therapy are randomized to 1 of 3 treatment arms. Patients in arm A receive bevacizumab IV over 30-90 minutes on day 1 of every cycle until progression or unacceptable toxicity.
Induction Therapy: Patients receive paclitaxel IV over 3 hours, carboplatin IV over 15-30 minutes, and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Maintenance Therapy: Patients achieving complete response, partial response or stable disease following induction therapy are randomized to 1 of 3 treatment arms. Patients in arm B receive pemetrexed IV over 10 minutes on day 1 of every cycle until progression or unacceptable toxicity.
Induction Therapy: Patients receive paclitaxel IV over 3 hours, carboplatin IV over 15-30 minutes, and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Maintenance Therapy: Patients achieving complete response, partial response or stable disease following induction therapy are randomized to 1 of 3 treatment arms. Patients in arm C receive bevacizumab as in arm A and pemetrexed as in arm B.