Bevacizumab and Low-Dose Cyclophosphamide in Treating Patients With Recurrent Ovarian Epithelial or Primary Peritoneal Cancer

Inclusion Criteria:

• Histologically confirmed recurrent or metastatic ovarian epithelial or primary peritoneal cancer

• Unidimensionally measurable disease

  • Previously irradiated indicator lesions must have progressed after radiotherapy
• Received a platinum-containing regimen for primary disease

• No more than 2 prior chemotherapy regimens for recurrent disease

  • Must have received prior platinum-based chemotherapy for recurrent disease if it has been > 12 months since treatment for primary disease (except if hypersensitivity to platinum has developed)
  • Rechallenge with the same platinum-based regimen is considered 1 prior regimen
• No history or clinical evidence of CNS disease, including primary brain tumor
• No brain metastases
• Performance status - SWOG 0-2
• At least 3 months
• Absolute neutrophil count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3
• No bleeding diathesis
• No coagulopathy
• Bilirubin no greater than 1.5 times normal
• ALT or AST no greater than 3 times upper limit of normal
• INR less than 1.5 (for patients receiving warfarin)
• Creatinine no greater than 1.5 times normal
• No proteinuria (less than 1+)
• Proteinuria less than 500 mg/24-hour urine collection
• No prior deep vein thrombosis
• No prior stroke
• No clinically significant cardiovascular disease

• None of the following within the past year:

  • Uncontrolled hypertension
  • New York Heart Association class II-IV congestive heart failure
  • Serious cardiac arrhythmia requiring medication
  • Grade II or greater peripheral vascular disease

• None of the following within the past 6 months:

  • Unstable angina
  • Myocardial infarction
  • Transient ischemic attack
  • Cerebrovascular accident
  • Other arterial thromboembolic event
• No clinically significant peripheral artery disease
• No active infection requiring parenteral antibiotics
• No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
• Not pregnant or nursing
• Fertile patients must use effective contraception
• No serious, non-healing wound, ulcer, or bone fracture
• No significant traumatic injury within the past 28 days
• No seizures not controlled with standard medical therapy

• No other malignancy within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix

  • All prior invasive malignancies must be in complete remission
• No other concurrent medical, psychological, or social condition that would preclude study participation
• No prior antiangiogenesis agents
• See Disease Characteristics
• Recovered from prior chemotherapy
• See Disease Characteristics
• Recovered from prior radiotherapy
• More than 28 days since prior major surgical procedure or open biopsy and recovered
• At least 3 weeks since prior therapy directed at the malignancy

• No recent or concurrent full-dose anticoagulants or thrombolytic agents

  • Anticoagulants to maintain patency of preexisting, permanent indwelling IV catheters allowed
• No concurrent chronic daily aspirin (greater than 325 mg/day) or nonsteroidal anti-inflammatory drugs known to inhibit platelet function