Cisplatin, Irinotecan, and Bevacizumab, in Treating Patients With Small Cell Lung Cancer

Inclusion Criteria:

All patients must have histologically or cytologically documented small cell carcinoma of the bronchus
The extensive disease classification for this protocol includes all patients with disease sites not defined as limited stage; limited stage disease category includes patients with disease restricted to one hemithorax with regional lymph node metastases, including hilar, ipsilateral and contralateral mediastinal, and/or ipsilateral supraclavicular nodes; extensive stage patients are defined as those patients with extrathoracic metastases, malignant pleural effusion, bilateral or contralateral supraclavicular adenopathy or contralateral hilar adenopathy
Measurable or Non-measurable Disease
No prior chemotherapy or investigational therapy for SCLC
Radiation therapy must have been completed at least three weeks before initiation of protocol therapy
No major surgical procedure within 28 days prior to starting treatment and fully recovered
No minor surgical procedure (mediastinoscopy or core biopsy) within 7 days prior to starting treatment
ECOG performance status: 0-2
No "currently active" second malignancy other than non-melanoma skin cancers
No CNS metastases; patients with a history of CNS metastases will NOT be eligible even if they have completed a course of CNS radiotherapy; all patients will have a screening brain CT or MRI to rule out occult CNS metastases
No recent history of CVA (within 6 months)
No serious or non-healing wound ulcer or bone fracture
Patients with a history of significant bleeding episodes (e.g., hemoptysis, bleeding diathesis, upper or lower GI bleeding) are not eligible; patients with trace blood in the sputum ("blood tinged sputum") are eligible
No myocardial infarction or significant change in anginal pattern within one year or current congestive heart failure (NYHA Class 2 or higher)
Patients with a history of hypertension must be well controlled (< 150/90) on a stable regimen of anti-hypertensive therapy
No HIV-positive patients receiving combination anti-retroviral therapy because of possible pharmacokinetic interactions with the protocol treatment; (patients with immune deficiency are at an increased risk of lethal infections when treated with marrow-suppressive therapy)
No chronic daily treatment with aspirin (> 325 mg/day) or on non-steroidal antiinflammatory agents known to inhibit platelet function; no treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), cilostazol (Pletal), or other antiplatelet agents
No clinically significant peripheral neuropathy (grade >= 2)
No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
No treatment with therapeutic anticoagulation; prophylactic anticoagulation for central venous access devices is allowed provided requirements of INR < 1.5 and PTT < 1.2 x ULN are met; caution should be taken in treating patients with low dose heparin or low molecular weight heparin for DVT prophylaxis as there may be an increased bleeding risk with bevacizumab
No current and/or recent (within 1 month) use of a thrombolytic agent; low dose thrombolytic therapy for maintenance of central venous catheter is allowed
No clinically significant peripheral arterial disease
Non-pregnant and non-nursing; the effect of the combination of bevacizumab, cisplatin, and irinotecan on the fetus and infant is unknown
Granulocytes >= 1,500/μl
Platelets >= 100,000/μl
Serum Creatinine =< ULN
Total Bilirubin < 2.0 mg/dl
SGOT < 2 x ULN
INR < 1.5
PTT < 1.2 x ULN
Urine protein (dipstick) < 1+