Bevacizumab, Cisplatin, Etoposide, and Radiation Therapy in Treating Patients With Limited-Stage Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed small cell lung cancer (SCLC)

  • Limited-stage disease, defined as SCLC confined to ≥ 1 of the following:

    • One hemithorax
    • Ipsilateral supraclavicular fossa
• Measurable disease

• No malignant pleural effusion, contralateral hilar disease, or contralateral supraclavicular disease

  • Minimal pleural effusion visible on CT scan of the chest, but not evident on chest x-ray, allowed
• No completely surgically resected disease
• No CNS disease, including primary brain tumor or brain metastasis

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• Absolute granulocyte count ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Bilirubin ≤ 1.5 mg/dL
• Creatinine ≤ 1.5 mg/dL
• Urine protein:creatinine ratio ≤ 0.5 OR 24-hour urine protein < 1,000 mg
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment
• INR ≤ 1.5 (unless on full-dose anticoagulants)
• No active serious infection
• No serious or nonhealing wound
• No ulcer or bone fracture
• No evidence of bleeding diatheses or coagulopathy
• No hemoptysis
• No known hypersensitivity to Chinese hamster ovary cell products and/or other recombinant human antibodies

• No clinically significant cardiovascular disease, including any of the following:

  • Uncontrolled hypertension
  • New York Heart Association class II-IV congestive heart failure
  • Serious cardiac arrhythmia requiring medication
  • Unstable angina pectoris
  • Symptomatic peripheral vascular disease
  • Cerebrovascular accident within the past 6 months
  • Symptomatic heart disease within the past 6 months
  • Myocardial infarction within the past 6 months
  • Unstable angina within the past 6 months
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 4 weeks
• No significant traumatic injury within the past 4 weeks

PRIOR CONCURRENT THERAPY:

• At least 4 weeks since prior major surgery or open biopsy
• At least 1 week since prior core biopsy
• No prior chemotherapy or radiotherapy for small cell lung cancer
• No concurrent major surgery
• No concurrent palliative local radiotherapy
• No concurrent intensity-modulated radiotherapy

• Concurrent full-dose anticoagulants (e.g., warfarin) allowed provided all of the following criteria are met:

  • INR ≤ 3
  • In-range INR (2-3) on a stable dose of oral anticoagulant or on a stable dose of low molecular weight heparin
  • No active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)