Radiation Therapy, Chemotherapy, and Bevacizumab in Treating Patients With Recurrent, Unresectable or Stage III or Stage IV Non-Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)

  • Predominantly squamous cell histology
  • Cytologic or histologic elements can be established on metastatic tumor aspirates or biopsy

• Advanced disease, meeting 1 of the following staging criteria:

  • Stage IIIB disease with malignant pleural effusion
  • Stage IV disease
  • Recurrent, unresectable disease
• Measurable or nonmeasurable disease
• No extrathoracic only disease
• No known CNS metastases by head CT scan with contrast or MRI

PATIENT CHARACTERISTICS:

• ECOG performance status 0-1
• Platelet count > 100,000/mm^3
• Absolute neutrophil count > 1,500/mm^3
• Bilirubin < 1.5 mg/dL
• Transaminases < 5 times upper limit of normal (ULN)
• Creatinine clearance ≥ 45 mL/min
• Urine protein:creatinine ratio ≤ 1.0 by spot urinalysis
• INR < 1.5 ULN
• PTT normal
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients use effective contraception
• No serious nonhealing wound, ulcer, or bone fracture
• No ongoing or active infection
• No ongoing fever
• No myocardial infarction within the past 6 months
• No stroke within the past 6 months
• No history of hypertension unless well-controlled (i.e., blood pressure < 150/100 mmHg on a stable regimen of antihypertensive therapy)
• No New York Heart Association grade III or IV congestive heart failure
• No serious cardiac arrhythmia requiring medication
• No unstable angina pectoris
• No peripheral vascular disease ≥ grade 2
• No other clinically significant cardiovascular disease
• No abdominal fistula
• No gastrointestinal perforation
• No intra-abdominal abscess within the past 6 months
• No psychiatric illness or social situation that would preclude study compliance
• No other malignancy curatively treated within the past 5 years
• No history of thrombotic or hemorrhagic disorders
• No gross hemoptysis (i.e., red blood ≥ ½ teaspoon) within the past 3 months
• No bleeding requiring intervention or ≥ grade 2

PRIOR CONCURRENT THERAPY:

• Recovered from prior therapy
• No prior systemic chemotherapy for metastatic NSCLC
• More than 6 months since prior adjuvant chemotherapy for early stage (i.e., stage IB-IIIA) NSCLC
• More than 3 weeks since prior immunotherapy, hormonal therapy, or radiotherapy
• More than 28 days since prior and no concurrent major surgery
• More than 7 days since prior minor surgery, fine-needle aspiration, or core biopsy
• More than 4 weeks since prior and no concurrent participation in another experimental drug study

• No concurrent therapeutic anticoagulation

  • Concurrent prophylactic anticoagulation of venous access device allowed
• No concurrent chronic treatment with aspirin (> 325 mg/day) or nonsteroidal anti-inflammatory drugs known to inhibit platelet function
• No concurrent dipyridamole, ticlopidine, clopidogrel, or cilostazol