Bevacizumab, Sorafenib Tosylate, and Temsirolimus in Treating Patients With Metastatic Kidney Cancer

Inclusion Criteria

• Patients will be required to have the clear cell variant of renal cell carcinoma with less than 25% of any other histology (including, but not limited to, papillary or chromophobe or oncocytic); there must be histologic confirmation by treating center of either primary or metastatic lesion
• Patients will be required to have measurable metastatic disease that is not curable by standard radiation therapy or surgery; all sites must be assessed within 4 weeks prior to study entry
• Previous nephrectomy is required with the following exceptions:
• Primary tumor = 30% of liver parenchymal) or multiple (> 5) bone metastases, making nephrectomy a clinically questionable procedure
• Unresectable primary tumor due to invasion into adjacent organs or encasing the aorta or vena cava
• No prior cytotoxic chemotherapy; a maximum of one prior regimen of either vaccine or cytokine-based immunotherapy disease is permitted
• No prior anti-angiogenic therapy including, but not limited to, SU11248, ZD6474 or VEGF Trap; no prior therapy with bevacizumab, mammalian target of rapamycin (mTOR) inhibitors (including, but not limited to, temsirolimus), or sorafenib will be allowed; thalidomide or interferon alpha (IFNalpha) are allowed either for adjuvant therapy or stage IV disease
• No immunotherapy within 4 weeks of randomization; toxicities from immunotherapy must have resolved and a minimum of two weeks must pass prior to enrollment
• Prior radiation therapy is permitted, but toxicities from radiation must have resolved and a minimum of 2 weeks must pass prior to randomization
• No history or clinical evidence of central nervous system (CNS) disease, including primary brain tumor, seizures not controlled with standard medical therapy, any brain metastasis, or history of stroke within the past 48 weeks
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
• Life expectancy of greater than 12 weeks
• Hemoglobin (Hgb) >= 9.0 g/dL (transfusions allowed prior to enrollment)
• White blood count (WBC) >= 3,000/mm^3
• Absolute granulocyte count (AGC) >= 1,200/mm^3
• Platelet count >= 100,000/mm^3
• Serum creatinine = = 55 ml/min
• Total bilirubin = = 5 years prior to the time of randomization
• No history of allergic reactions attributed to Chinese hamster ovary cell products, other recombinant human antibodies, or compounds of similar chemical or biologic composition to sorafenib, temsirolimus or bevacizumab
• No history of bleeding diathesis or coagulopathy
• Any condition that impairs patient's ability to swallow pills will make patient ineligible
• No major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to randomization
• No anticipated need for major surgery during the course of the study
• No current or recent (within 4 weeks of enrollment) use of full-dose of anticoagulants or thrombolytic agents (except as required to maintain patency of preexisting or permanent indwelling IV catheters, for those patients receiving warfarin, INR must be = 150/100 mm/Hg at the time of enrollment); patients with hypertension and blood pressure = 0.5, 24-hour urine protein is to be obtained and the level must be < 1000 mg for patient enrollment
• NOTE: UPC ratio of spot urine is an estimation of the 24 urine protein excretion; a UPC ratio of 1 is roughly equivalent to a 24-hour urine protein of 1 gm
• No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring parenteral antibiotics on day 0 or psychiatric illness/social situations that would limit compliance with study requirements
• Patients currently taking any of the following cytochrome P450 enzyme-inducing drugs are ineligible:
• Phenytoin
• Carbamazepine
• Phenobarbital
• Rifampin
• Pregnant and breastfeeding women are excluded from the study; breastfeeding should be discontinued while receiving therapy; patients must have pregnancy test within 7 days prior to patient randomization