Intervention: Sorafenib
Trial phase: Phase 2
ATC code: L01EX02 | L01XE05
SMILES: CNC(=O)c1cc(Oc2ccc(NC(=O)Nc3ccc(Cl)c(C(F)(F)F)c3)cc2)ccn1
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 79
Group description: bevacizumab: Given IV
Eligibility criteria:
Inclusion Criteria:

Diagnosis of stage IV colorectal cancer (histologic proof is not required)

Measurable disease

Spiral CT scan required for both pre- and post-treatment tumor assessments of lesions measuring 1-2 cm
Progressive disease during or within 6 months of most recent prior chemotherapy regimen (bevacizumab, fluoropyrimidine, oxaliplatin, or irinotecan-based treatment) OR considered ineligible for standard therapy
Documentation of submission of tumor material for Kirsten Rat Sarcoma (KRAS) testing available
Prior anti-epidermal growth factor receptor (EGFR) antibody therapy (e.g., cetuximab or panitumumab) required for patients with wild-type KRAS tumor

No known brain metastasis

Patients with neurological symptoms must undergo a CT scan or MRI of the brain to exclude brain metastasis
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Life expectancy ≥ 6 months
Hemoglobin ≥ 9.0 g/dL
Absolute neutrophil count (ANC) ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
White blood cell count (WBC) ≥ 3,400/mm³
International normalized ratio (INR) < 1.5 (≤ 3.0 if on anti-coagulation therapy [e.g., warfarin or heparin])
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
Aspartate aminotransferase (AST) ≤ 2.5 times ULN (≤ 5 times ULN if there is liver involvement)
Alkaline phosphatase ≤ 3 times ULN
Creatinine ≤ 1.5 times ULN
Urine protein:creatinine ratio < 1 OR urine dipstick < 2+ OR urine protein < 1,000 mg by 24-hour urine collection
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment (≥ 2 weeks after completion of treatment with sorafenib tosylate alone)
Willing to provide mandatory blood samples for translational research studies
Able to swallow whole pills
No inadequately controlled hypertension (i.e., systolic BP > 150 mm Hg or diastolic BP > 100 mm Hg on anti-hypertensive medications)
No prior hypertensive crisis or hypertensive encephalopathy
No myocardial infarction or unstable angina within the past 6 months
No congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
No thrombolic or embolic events (e.g., cerebrovascular accident, including transient ischemic attacks) within the past 6 months
No hemorrhage or bleeding event > grade 3 within the past 4 weeks
No evidence or history of bleeding diathesis or coagulopathy (in the absence of therapeutic anticoagulation)
No greater than normal risk of bleeding
No active or recent hemoptysis (≥ ½ teaspoon of bright red blood per episode) within the past 30 days

No concurrent uncontrolled illness including, but not limited to, any of the following:

Ongoing or active infection
Symptomatic congestive heart failure
Unstable angina pectoris
Cardiac arrhythmia requiring anti-arrhythmic drugs
Psychiatric illness or social situations that would limit compliance with study requirements
No known HIV infection or chronic hepatitis B or C infection

No serious, non-healing wound, active ulcer, or untreated bone fracture

Patients with fractures secondary to metastatic disease are eligible after appropriate radiotherapy
No significant traumatic injury within the past 4 weeks
No known or suspected allergy or hypersensitivity to any component of bevacizumab, sorafenib tosylate, or their excipients or to any other agent given in the course of this study
No malabsorption problem

None of the following within the past 6 months:

Significant vascular disease (e.g., aortic aneurysm or aortic dissection)
Peripheral arterial thrombosis
Symptomatic peripheral vascular disease
Abdominal fistula
Gastrointestinal perforation
Intra-abdominal abscess

No other active malignancy within the past 3 years except non melanoma skin cancer or carcinoma in situ of the cervix

Prior malignancy allowed provided patient is not receiving other specific treatment for that malignancy (other than hormonal therapy)
No other concurrent investigational agent for this cancer
Prior radiotherapy allowed
No prior sorafenib tosylate
No prior discontinuation of bevacizumab due to adverse events
More than 4 weeks since prior and no concurrent participation in any other experimental drug study
More than 4 weeks since prior St. John's wort or rifampin
More than 4 weeks since prior and no concurrent major surgical procedure or open biopsy
More than 7 days since prior core biopsy or minor surgical procedure, including placement of a vascular access device
No concurrent anticoagulant, except low-dose warfarin or heparin for deep venous thrombosis prophylaxis