A Phase II Study of Bevacizumab in Patients With Nonresectable Cancer of the Adrenal Cortex.

Inclusion Criteria:

- Subjects must provide written informed consent

- Subjects must be 18 years of age or older

- Subjects must have histologically confirmed ACC by the Department of Pathology at
Dartmouth-Hitchcock Medical Center

- Subjects must have inoperable disease

- This is a first and/or second line study. Patients must have completed only one or
fewer regimes of systemic therapy. They may have received one prior systemic therapy
either: a) mitotane, or b)chemotherapy, or c) experimental therapy, or d) concurrent
chemotherapy and mitotane, or e) no prior systemic therapy

- Subjects must have a life expectancy of three or more months

- If subjects have received some form of systemic therapy (e.g. chemotherapy or
mitotane), they should have completed that systemic therapy at least 28 days before
beginning Bevacizumab

- All subjects of child-bearing potential(men and women) must agree to the use of
effective means of contraception

Exclusion Criteria:

- Other co-existing malignancies or malignancies diagnosed within the last 5 years wtih
the exception of basal cell carcinoma or cervical cancer in situ

- Any unresolved chronic toxicity greater than CTC grade 2 from previous anticancer
therapy (except alopecia)

- absolute neutrophil counts less than 1.5 x l,000,000,000/liter, or platelets less
than 20.0 x 1,000,000,000/liter

- As judged by the investigator, any evidence of severe or uncontrolled systemic
disease (e.g., unstable or uncompensated respiratory,cardiac, hepatic, or renal
disease)

- Evidence of any other significant clinical disorder or laboratory finding that makes
it undesirable for the subject to participate in the trial

- Prior therapy with two or more systemic therapy regimes. In other words if a patient
is seeking third line therapy or later than third line therapy he is ineligible for
this study

- Current, recent(within 4 weeks of the first infusion of this study), or planned
participation in an experimental drug study other than a Genentech- sponsored
Bevacizumab cancer study

- Prior use of Bevacizumab or any other anti-VEGF therapies

- Known hypersensitivity to Bevacizumab

- Inadequately controlled hypertension (defined as systolic blood pressure of >150 mm
Hg and/or diastolic blood pressure >100 mm Hg on anti- hypertensive medications

- Any prior history of hypertensive crisis or hypertensive encephalopathy

- Unstable angina

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

- History of myocardial infarction within 6 months

- History of stroke or transient ischemic attack at any time prior to study enrollment

- Clinically significant peripheral vascular disease

- Evidence of bleeding diathesis or coagulopathy

- Presence of central nervous system or brain metastases

- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 0, anticipation of need for major surgical procedure during the course
of the study

- Core biopsies or other minor surgical procedures, excluding placement of a vascular
access device, within 7 days prior to Day 0

- Pregnant (positive pregnancy test) or lactating

- Women who are fertile and not willing to practice abstinence or an adequate form of
contraception (i.e. use or oral contraceptives, intrauterine devices or barrier
protection)

- Urine protein: creatinine ratio > 1.0 at screening -History of abdominal fistula,
gastrointestinal perforation, or intr- abdominal abcess within 6 months prior to Day
0

- Serious, non-healing wound, ulcer, or bone fracture

- Lung lesions of any etiology(malignant or nonmalignant) in close proximity to a major
vessel

- Cavitary lung lesions (to prevent episodes of potentially life-threatening
hemoptysis)

- History of hemoptysis (defined as bright red blood of 1/2 teaspoon or more)

- Inability to comply with study and/or follow-up procedures