Bevacizumab in Reducing CNS Side Effects in Patients Who Have Undergone Radiation Therapy to the Brain for Primary Brain Tumor, Meningioma, or Head and Neck Cancer
Condition: Adult Anaplastic Astrocytoma; Adult Anaplastic Ependymoma; Adult Anaplastic Meningioma; Adult Anaplastic Oligodendroglioma; Adult Brain Stem Glioma; Adult Central Nervous System Germ Cell Tumor; Adult Choroid Plexus Tumor; Adult Diffuse Astrocytoma; Adult Ependymoma; Adult Grade II Meningioma; Adult Grade III Meningioma; Adult Malignant Hemangiopericytoma; Adult Mixed Glioma; Adult Oligodendroglioma; Adult Papillary Meningioma; Adult Pineocytoma; Malignant Neoplasm; Meningeal Melanocytoma; Radiation Toxicity; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Adult Brain Tumor; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage I Adenoid Cystic Carcinoma of the Oral Cavity; Stage I Basal Cell Carcinoma of the Lip; Stage I Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage I Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage I Lymphoepithelioma of the Nasopharynx; Stage I Lymphoepithelioma of the Oropharynx; Stage I Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage I Mucoepidermoid Carcinoma of the Oral Cavity; Stage I Salivary Gland Cancer; Stage I Squamous Cell Carcinoma of the Hypopharynx; Stage I Squamous Cell Carcinoma of the Larynx; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage I Squamous Cell Carcinoma of the Nasopharynx; Stage I Squamous Cell Carcinoma of the Oropharynx; Stage I Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage I Verrucous Carcinoma of the Larynx; Stage I Verrucous Carcinoma of the Oral Cavity; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Basal Cell Carcinoma of the Lip; Stage III Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage III Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Salivary Gland Cancer; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Basal Cell Carcinoma of the Lip; Stage IV Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage IV Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Lymphoepithelioma of the Oropharynx; Stage IV Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage IV Mucoepidermoid Carcinoma of the Oral Cavity; Stage IV Salivary Gland Cancer; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity
MeSH terms: Carcinoma; Neoplasms; Carcinoma, Squamous Cell; Glioma; Brain Neoplasms; Astrocytoma; Laryngeal Neoplasms; Carcinoma, Basal Cell; Oropharyngeal Neoplasms; Carcinoma, Verrucous; Squamous Cell Carcinoma of Head and Neck; Papilloma; Meningioma; Ependymoma; Oligodendroglioma; Salivary Gland Neoplasms; Nasopharyngeal Carcinoma; Paranasal Sinus Neoplasms; Carcinoma, Adenoid Cystic; Carcinoma, Mucoepidermoid; Mucoepidermoid Tumor; Esthesioneuroblastoma, Olfactory; Papilloma, Inverted; Choroid Plexus Neoplasms; Hemangiopericytoma; Solitary Fibrous Tumors; Pinealoma; Laryngeal Diseases; Granuloma; Recurrence
Intervention: bevacizumab; placebo; magnetic resonance imaging; quality-of-life assessment
Intervention description: Given IV; Given IV
Intervention MeSH terms: Bevacizumab; Antineoplastic Agents, Immunological; Antibodies; Immunoglobulins; Antibodies, Monoclonal
Phase: Phase 2
Study type: Interventional
Primary purpose: Supportive Care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Enrollment: 11.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      Bevacizumab may reduce CNS side effects caused by radiation therapy. This randomized phase II
      trial is studying how well bevacizumab works in reducing CNS side effects in patients who
      have undergone radiation therapy to the brain for primary brain tumor, meningioma, or head
      and neck cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  No evidence of bleeding diathesis or coagulopathy

          -  Fertile patients must use effective contraception during and for >= 2 months after
             completion of study therapy

          -  No diarrhea >= grade 1

          -  Histologically confirmed primary brain neoplasm, meningioma, or head and neck cancer
             [WHO grade 2 or 3 disease--no WHO grade 4 primary brain neoplasms (i.e., glioblastoma
             or gliosarcoma)]

          -  Patients with head and neck cancer must not have any of the following:

               -  Evidence of metastatic disease

               -  Evidence of tumor invasion to major vessels (e.g., the carotid)

               -  History of bleeding related to tumor or radiotherapy during or after completion
                  of radiotherapy

          -  Must have undergone cranial irradiation

          -  Must have radiographic evidence to support the diagnosis of radiation necrosis and/or
             surgical biopsy evidence of necrosis without tumor within the past 2 months

          -  Must have evidence of progressive neurologic signs or symptoms appropriate to the
             location of the radiation necrosis

          -  No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
             the past 28 days

          -  No significant traumatic injury within the past 28 days

          -  No evidence of active CNS hemorrhage

          -  Karnofsky performance status 60-100%

          -  No clinically significant cardiovascular disease, including any of the following:

               -  Inadequately controlled hypertension (i.e., systolic BP > 140 mm Hg and/or
                  diastolic BP > 90 mm Hg despite antihypertensive medication)

               -  Large vessel cerebrovascular accident within the past 6 months

               -  Myocardial infarction or unstable angina within the past 6 months

          -  No clinically significant cardiovascular disease, including any of the following:

               -  NYHA class II-IV congestive heart failure

               -  Serious or inadequately controlled cardiac arrhythmia

               -  Significant vascular disease (e.g., aortic aneurysm or history of aortic
                  dissection)

               -  Clinically significant peripheral vascular disease

          -  At least 6 months since prior radiotherapy

          -  Platelet count > 75,000/mm^3

          -  Granulocyte count > 1,500/mm^3

          -  Creatinine < 1.0 times ULN

          -  AST < 2.5 times ULN

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Prior chemotherapy for tumor allowed

          -  Prior tyrosine kinase inhibitors of VEGF receptor (VEGFR) allowed

          -  More than 28 days since prior and no concurrent major surgical procedure or open
             biopsy

          -  Concurrent dexamethasone allowed provided patient is on a stable dose for >= 1 week
             prior to study entry

          -  Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed
             provided the following criteria are met:

               -  In-range INR (usually between 2 and 3) and patient is on a stable dose of oral
                  anticoagulant for 1 week or on a stable dose of low molecular weight heparin

               -  No active bleeding or pathological condition that carries a high risk of bleeding

          -  Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed
             provided the following criteria are met: No evidence of serious or nonhealing wound,
             ulcer, or bone fracture

          -  No concurrent chemotherapy or tyrosine kinase inhibitors of VEGFR

          -  No prior bevacizumab

          -  More than 7 days since prior core biopsy

          -  History of seizures allowed provided the patient is receiving anticonvulsant therapy

          -  Hemoglobin >= 9.0 g/dL

          -  Bilirubin =< 1.5 times upper limit of normal (ULN)

          -  No other concurrent investigational agents