Ziv-aflibercept in Treating Patients With Locally Advanced, Unresectable, or Metastatic Gynecologic Soft Tissue Sarcoma

Inclusion Criteria:

Histologically/cytologically confirmed soft tissue sarcoma of gynecologic tract including 1 of the following subtypes: uterine leiomyosarcoma, malignant mixed mullerian tumor/carcinosarcoma, disease originating in ovary/fallopian tube allowed
Locally advanced/unresectable/metastatic disease
Previously treated disease must have radiographic/clinical evidence of PD
Measurable disease-at least 1 lesion in at least 1 dimension (longest diameter) as >=20mm with conventional techniques or as >=10mm with spiral CT scan
Indicator lesions may not have been previously treated with surgery/radiotherapy/radiofrequency ablation unless PD has been confirmed
ECOG PS 0-2 OR Karnofsky PS 60-100%
Life expectancy>=3 months
WBC>=3,000/mm^3
Absolute neutrophil count>=1,500/mm^3
Platelet count>=75,000/mm^3
Bilirubin=<1.5xULN
AST and ALT=<3xULN
INR=<1.5 (unless on warfarin)
Creatinine=<1.5xULN OR creatinine clearance>=60 mL/min
Urine protein<1+ by dipstick OR 24-hour urine protein<500 mg OR urine protein:creatinine ratio<1
Not pregnant/nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for ≥6 months after treatment - No other active malignancy within past 5 years except adequately treated cervical carcinoma in situ/nonmelanoma skin cancer
No known hypersensitivity to Chinese hamster ovary cell products/other recombinant human antibodies
No history of allergic reactions attributed to compounds of similar chemical/biological composition to study agents
No serious/nonhealing wound/ulcer/bone fracture
No abdominal fistula/gastrointestinal perforation/bowel obstruction/intraabdominal abscess within past 28 days
No significant traumatic injuries within past 28 days
No evidence of bleeding diathesis/coagulopathy
No uncontrolled intercurrent illness including but not limited to: Ongoing/active infection, psychiatric illness or social situations that would preclude study compliance
<=2 prior cytotoxic chemotherapy regimen for recurrent, locally advanced or metastatic disease
Recovered from prior therapy
No prior antiangiogenic agent

Exclusion Criteria:

< 4weeks since prior chemotherapy (<6 weeks for nitrosoureas/carmustine/mitomycin C), prior investigational treatment, radiotherapy and major surgery/open biopsy
1 week since prior core biopsy
1 month since prior thrombolytic agents
Concurrent full-dose anticoagulants with INR>1.5 allowed if: In-range INR (usually between 2-3) on stable dose of oral anticoagulant or low molecular weight heparin,
OR; For patients on warfarin, the upper target for INR is ≤3 No active bleeding/pathological condition that carries a high risk of bleeding (e.g. tumor invading major vessels/known varices)
No evidence of CNS disease including primary brain tumor/brain metastasis
No other concurrent investigational agents - No concurrent major surgery
No concurrent combination antiretroviral therapy for HIV-positive patients

Clinically significant cardiovascular disease including:

Cerebrovascular accident within past 6 months,
Uncontrolled hypertension defined as BP>150/100mmHg OR systolic BP>180mmHg if diastolic BP<90 mmHg, on ≥2 repeated determinations on separate days within past 3 months,
OR; Antihypertensive medications allowed as long as dose and number of antihypertensive medications have not increased within past 2 weeks, Myocardial infarction, coronary artery bypass graft, or unstable angina within past 6 months, OR;
OR; NYHA class III-IV congestive heart failure, serious cardiac arrhythmia requiring medication, or unstable angina pectoris within past 6 months, Clinically significant peripheral vascular disease within past 6 months
OR; pulmonary embolism, deep vein thrombosis, or other thromboembolic event within past 6 months