Bevacizumab, Cisplatin, Radiation Therapy, and Fluorouracil in Treating Patients With Stage IIB, Stage III, Stage IVA, or Stage IVB Nasopharyngeal Cancer

Inclusion Criteria

• Histologically confirmed cancer of the nasopharynx based on biopsy of a primary lesion and/or lymph nodes
• Histologic WHO types I-IIb/III
• Stage IIB-IVB disease
• No T1-2, N1 disease in which node positivity is based on the presence of retropharyngeal lymph nodes
• No distant metastases
• Zubrod performance status 0-1
• WBC ? 4,000/mm?
• Hemoglobin ? 9.0 g/dL
• Platelet count ? 100,000/mm?
• Absolute neutrophil count ? 1,500/mm?
• INR ? 1.5
• aPTT ? 1.5 times upper limit of normal (ULN)
• Alkaline phosphatase ? 1.5 times ULN
• ALT and AST ? 1.5 times ULN
• Bilirubin ? 1.5 times ULN
• Creatinine ? 1.5 mg/dL OR creatinine clearance ? 55 mL/min
• Urine protein: creatinine (UPC) ratio 0.5, 24-hour urine protein must be 15% from baseline)
• History of arterial thromboembolic events
• Acquired immune deficiency syndrome
• Transmural myocardial infarction
• Cerebrovascular accident
• Transient ischemic attack
• Any other cardiac condition that, in the opinion of the investigator, would preclude study compliance
• No gross hemoptysis or hematemesis, defined as bright red blood of ? 1 teaspoon per coughing episode, within the last 4 weeks (incidental blood mixed with phlegm allowed)
• No other invasive malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the breast, oral cavity, or cervix
• Nutritional and physical condition considered suitable for study treatment
• No significant traumatic injury within the past 4 weeks
• No history of allergic reaction to the study drugs
• No baseline blood pressure > 150/100 mm Hg
• No peripheral neuropathy ? grade 2
• Not pregnant or nursing
• Negative serum pregnancy test
• Fertile patients must use effective contraception during and for ? 6 months after completion of study treatment
• At least 10 days since prior and no concurrent dipyridamole, ticlopidine, clopidogrel bisulfate, cilostazol, warfarin, heparin, daily treatment with acetylsalicylic acid (> 325 mg/day), or nonsteroidal anti-inflammatory medications known to inhibit platelet function
• No prior head and neck surgery of the primary tumor or lymph nodes except for incisional or excisional biopsies
• More than 15 days since prior biopsies
• More than 1 week since prior fine-needle aspirations or placement of percutaneous gastrostomy tube
• More than 4 weeks since prior major surgical procedures
• No prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
• No prior bevacizumab or other vascular endothelial growth factor-targeting agents
• No prior systemic chemotherapy for the study cancer
• Prior chemotherapy for a different cancer allowed
• No concurrent hematologic growth factors (e.g. filgrastim [G-CSF], darbepoetin alfa, epoetin alfa) during study chemoradiotherapy
• No concurrent prophylactic growth factors for neutropenia during study adjuvant therapy
• No concurrent prophylactic amifostine or pilocarpine
• No other concurrent experimental therapeutic cancer treatments