Carboplatin, Pemetrexed Disodium, and Bevacizumab for Patients With Stage III or IV Non-Small Cell Lung Cancer Who Are Light/Never Smokers

DISEASE CHARACTERISTICS:

Histologically confirmed primary lung carcinoma

Non-squamous histology
Advanced disease defined as stage IIIB disease with cytologically documented malignant pleural or pericardial effusion or stage IV disease

Available pathology block or unstained slides from initial or subsequent diagnosis

Must have undergone ≥ 1 core biopsy
No patients whose diagnosis was made through a fine-needle aspirate
No uncontrolled pleural effusions, ascites, or third-space fluid collections

Meets 1 of the following criteria:

Non-smoker, defined as patients who smoked ≤ 100 cigarettes in their lifetime
Former light smoker, defined as patients who smoked between > 100 cigarettes AND ≤ 10 pack-years AND quit ≥ 1 year ago

No known central nervous system disease, except for treated brain metastases meeting the following criteria:

No evidence of progression or hemorrhage after treatment
No ongoing requirement for dexamethasone as ascertained by clinical examination and brain imaging (MRI or CT scan) during the screening period
Stable doses of anticonvulsants are allowed
Treatment for brain metastases may include whole-brain radiotherapy, radiosurgery (gamma knife, LINAC, or equivalent), or a combination as deemed appropriate by the treating physician
No patients with central nervous system (CNS) metastases treated by neurosurgical resection
No brain biopsy within the past 3 months

PATIENT CHARACTERISTICS:

Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Absolute neutrophil count (ANC) ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3
Hemoglobin ≥ 9.0 g/dL
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
Aspartate aminotransferase (AST/ALT) ≤ 2.5 times ULN
Calculated creatinine clearance > 45 mL/min OR creatinine ≤ 1.5 times ULN
Prothrombin time ≤ 1.5 times ULN
Partial thromboplastin time ≤ ULN
Urine protein:creatinine ratio ≤ 1.0
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception

Patients with a history of hypertension are eligible provided it is well controlled (BP < 150/100 mm Hg) on a stable regimen of antihypertensive therapy

No history of hypertensive crisis or hypertensive encephalopathy
Able and compliant with folic acid and B12 supplementation
Able to swallow tablets intact or dissolved in water
No dysphagia or active gastrointestinal (GI) disease or disorder that alters GI motility or absorption
No lack of integrity of the GI tract (e.g., a significant surgical resection of the stomach or small bowel)
No abdominal fistula, GI perforation, or intraabdominal abscess within the past 6 months

None of the following:

Ongoing or active infection
Symptomatic congestive heart failure (NYHA class II-IV)
Cardiac arrhythmia
Psychiatric illness, social situations, or any other medical condition that would limit compliance with study requirements
No myocardial infarction or other evidence of arterial thrombotic disease (angina) within the past 6 months
No history of cerebral vascular accident or transient ischemic attack within the past 6 months
No significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within the past 6 months
No history of bleeding diathesis or coagulopathy

No ongoing hemoptysis, defined as ≥ ½ teaspoon of bright red blood

Patients with procedure-related hemoptysis that has resolved post-procedure are eligible
No serious nonhealing wound, ulcer, bone fracture, or significant traumatic injury within the past 28 days
No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies

PRIOR CONCURRENT THERAPY:

No prior chemotherapy

Patient must be chemotherapy naive
Prior neoadjuvant or adjuvant chemotherapy allowed provided it was completed ≥ 6 months ago
No prior anti-vascular endothelial growth factor therapy
At least 3 weeks since prior major surgery
At least 1 week since prior radiotherapy
More than 28 days since prior and no concurrent treatment with an investigational agent
More than 7 days since prior core biopsy
Concurrent daily treatment with aspirin or NSAIDs are eligible provided patients are able to interrupt NSAIDs 2 days before (5 days for long-acting NSAIDs), the day of, and for 2 days following the administration of pemetrexed disodium
No concurrent treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), and/or cilostazol (Pletal)