Bevacizumab in Treating Patients With Recurrent Sex Cord-Stromal Tumors of the Ovary

PRIMARY OBJECTIVES:

I. To estimate the anti-tumor activity of bevacizumab by assessing frequency of objective
response in patients with recurrent sex cord-stromal tumors of the ovary who have measurable
disease.

SECONDARY OBJECTIVES:

I. To determine the nature and degree of toxicity in these patients. II. To determine the
overall survival and progression-free survival of these patients.

TERTIARY OBJECTIVES:

I. To quantify expression of angiogenic or lymphangiogenic markers in recurrent stromal
tumors of the ovary to determine the frequency of alterations and potential utility of
biologic agents directed at these proteins for inclusion in future studies.

OUTLINE:

Patients receive bevacizumab intravenously (IV) over 30-90 minutes on day 1. Courses repeat
every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 2 years, every
6 months for 3 years, and then periodically thereafter.

Inclusion Criteria:

- Patients diagnosed with histologically confirmed recurrent ovarian stromal tumor
(granulosa cell tumor, granulosa cell-theca cell tumor, Sertoli-Leydig cell tumor
[androblastoma], steroid [lipid] cell tumor, gynandroblastoma, unclassified sex
cord-stromal tumor, sex cord tumor with annular tubules)

- Patients must have measurable disease by Response Evaluation Criteria In Solid Tumors
(RECIST) criteria

- Measurable disease is defined as at least one lesion that can be accurately
measured in at least one dimension (longest dimension to be recorded); each
?target? lesion must be >= 20 mm when measured by conventional techniques,
including palpation, plain x-ray, computed tomography (CT), and magnetic
resonance imaging (MRI), or >= 10 mm when measured by spiral CT

- Patients must have a Gynecologic Oncology Group (GOG) performance grade of 0, 1, or 2

- Patients of childbearing potential must have a negative pregnancy test and must agree
to practice an effective means of birth control

- Patients who have met the pre-entry requirements specified

- There are no restrictions on prior therapy; however, patients cannot have previously
had treatment with bevacizumab

- Absolute neutrophil count (ANC) >= 1,000/?l

- Platelets greater than or equal to 75,000/?l

- Creatinine =< 1.5 x institutional upper limit normal (ULN)

- Bilirubin =< 1.5 x ULN

- Serum glutamic oxaloacetic transaminase (SGOT) less 2.5 x ULN

- Alkaline phosphatase less 2.5 x ULN

- Neuropathy (sensory and motor) less than or equal to Common Terminology Criteria for
Adverse Events (CTCAE) version (v)3.0 grade 1

- Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 (or an
in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic
warfarin) and a partial thromboplastin time (PTT) < 1.2 times the upper limit of
normal

- Patients must have signed an approved informed consent and authorization permitting
release of personal health information

Exclusion Criteria:

- Patients with newly diagnosed disease

- Patients with serious non-healing wound, ulcer, or bone fracture

- Patients who have received prior therapy with bevacizumab or other inhibitors of
vascular endothelial growth factor (VEGF)

- Patients with active bleeding or pathologic conditions that carry high risk of
bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major
vessels

- Patients with history or evidence upon physical examination of central nervous system
(CNS) disease, including primary brain tumor, seizures not controlled with standard
medical therapy, any brain metastases, or history of cerebrovascular accident (CVA,
stroke), transient ischemic attack (TIA), or subarachnoid hemorrhage within 6 months
of the first date of treatment on this study

- Patients with clinically significant cardiovascular disease; this includes:

- Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mm
Hg

- Myocardial infarction or unstable angina within 6 months prior to registration

- New York Heart Association (NYHA) grade II or greater congestive heart failure

- Serious cardiac arrhythmic requiring medication.

- Grade 2 or greater peripheral vascular disease

- Patients with GOG performance grade of 3 or 4

- Patients with clinically significant peripheral arterial disease; e.g., claudication
within 6 months

- Patients with known hypersensitivity to Chinese hamster ovary cell products or other
recombinant human or humanized antibodies

- Patients with clinically significant proteinuria; urine protein should be screened by
urine protein-creatinine ratio (UPCR); the UPCR has been found to correlate directly
with the amount of protein excreted in a 24 hour urine collection; specifically; a
UPCR of 1.0 is equivalent to 1.0 gram of protein in a 24 hour urine collection; obtain
at least 4 ml of a random urine sample in a sterile container (does not have to be a
24 hour urine); send sample to lab with request for urine protein and creatinine
levels (separate requests); the lab will measure protein concentration (mg/dL) and
creatinine concentration (mg/dL); the UPCR is derived as follows: protein
concentration (mg/dL)/creatinine (mg/dL); patients must have a UPCR < 1.0 to allow
participation in the study

- Patients with a history of cardiovascular accident (CVA) within 6 months prior to
registration

- Patients with any signs of bowel obstruction or patients who require parenteral
hydration and/or nutrition

- Patients whose circumstances do not permit completion of the study or the required
follow-up

- Patients who are pregnant or nursing; patients who may become pregnant must agree to
use contraceptive measures during the study and for at least 3 months after the
completion of bevacizumab therapy

- Patients who have a major surgical procedure, open biopsy, or significant traumatic
injury within 28 days prior to the first date of treatment on this study, or
anticipate the need for major surgical procedure during the course of the study;
patients with placement of vascular access device or core biopsy within 7 days prior
to the first date of treatment on this study

- Patients with active infection requiring parenteral antibiotics

- Patients with a history of other invasive malignancies, with the exception of
non-melanoma skin cancer, are excluded if there is any evidence of other malignancy
being present within the last five years; patients are also excluded if their previous
cancer treatment contraindicates this protocol therapy