Combination Chemotherapy and Bevacizumab in Treating Patients With Stage IV Colon Cancer That Cannot Be Removed By Surgery

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed adenocarcinoma of the colon

No histological findings other than adenocarcinoma of the colon
If the primary colon tumor and the metastatic lesions have been identified at the same time and it is not possible to biopsy the colonic lesion, the patient will be eligible without histologic confirmation of the primary cancer of the colon as long as other radiographic studies or scans document the characteristics of a colon cancer AND the biopsy of a metastatic site confirms diagnosis of adenocarcinoma suggestive of a primary tumor of the colon
Unresected primary tumor of the colon AND radiographically confirmed metastatic colon cancer (single or multiple sites of metastases) that are not considered surgically resectable for cure by chest imaging and CT scan or MRI of the abdomen within the past 4 weeks and by endoscopy within the past 8 weeks

Asymptomatic primary tumor

No obstruction, perforation, or active bleeding requiring transfusion
Distal extent of the tumor must be ≥ 12 cm from the anal verge on endoscopy
Not a candidate for curative surgical resection of all metastatic and colon primary tumors
No evidence of Central Nervous System (CNS) metastases
No recurrent local or metastatic disease after prior adjuvant therapy
No diagnosis of rectal carcinoma

PATIENT CHARACTERISTICS:

Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Absolute neutrophil count ≥ 1200/mm³
Platelet count ≥ 100,000/mm³
Hemoglobin ≥ 9 g/dL
Aspartate aminotransferase (AST) ≤ 2.5 times upper limit of normal (ULN) (≤ 5.0 times ULN if liver metastases are present)
Alkaline phosphatase ≤ 3.0 times ULN (≤ 5.0 times ULN if liver metastases are present)
Bilirubin ≤ 1.5 times ULN (≤ 2.0 times ULN if liver metastases are present)
Creatinine < 1.8 mg/dL

Urine dipstick indicating 0-1+ protein

If dipstick reading is ≥ 2+, a 24-hour urine collection must demonstrate < 1 g of protein

Prothrombin Time and International Normalized Ratio (PT/INR) ≤ 1.5 unless the patient is on therapeutic doses of warfarin, in which case the following criteria must be met:

Patient must have an in-range INR (between 2 and 3) on a stable dose of warfarin
Patient must not have active bleeding or a pathologic condition that is associated with a high risk of bleeding
Patients with a history of non-colorectal malignancies must be disease free for ≥ 5 years prior to study entry and be deemed at low risk for recurrence

Patients with the following cancers are eligible if diagnosed and treated within the past 5 years:

Carcinoma in situ of the colon
Melanoma in situ
Basal cell or squamous cell carcinoma of the skin
Carcinoma in situ of the cervix
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 3 months after the completion of study therapy
No uncontrolled blood pressure (BP), defined as BP > 150/100 mm Hg

No nonmalignant systemic disease that would preclude any of the study therapy drugs, compromise the safety of the patient, or inhibit the patient's ability to participate in the study, including any of the following:

New York Heart Association class III or IV cardiac disease
Myocardial infarction within the past 6 months
Unstable angina within the past 6 months
Symptomatic arrhythmia
No transient ischemic attack or cerebrovascular accident within the past 6 months
No symptomatic peripheral vascular ischemia within the past 6 months
No arterial thrombotic event within the past 6 months
No gastroduodenal ulcer(s) determined by endoscopy to be active
No gastrointestinal perforation within the past 12 months
No serious or nonhealing wound, skin ulcer, or bone fracture
No significant traumatic injury within the past 28 days
No significant episodes of acute bleeding requiring blood transfusion within the past 6 months
No clinically significant (≥ grade 2) peripheral neuropathy (neurosensory or neuromotor toxicity)
No pulmonary fibrosis or interstitial pneumonitis by chest x-ray
No psychiatric or addictive disorders or other conditions that would preclude the patient from meeting study requirements

PRIOR CONCURRENT THERAPY:

See Disease Characteristics
No prior systemic chemotherapy, radiation therapy, or surgery for this malignancy
No prior endoscopic management of this malignancy other than biopsy, including endoscopic stent placement, fulguration, or laser treatment
More than 30 days since prior investigational drugs
More than 28 days since prior major surgical procedure or open biopsy
More than 7 days since prior core biopsy or other minor procedure, excluding placement of a vascular access device
No concurrent major surgery unrelated to intact primary colon cancer
No concurrent radiotherapy
No concurrent filgrastim (G-CSF) or pegfilgrastim as primary prophylaxis for neutropenia
No concurrent halogenated antiviral agents
No other concurrent investigational drugs
No other concurrent antineoplastic agents