A Phase I/II Study Evaluating The Efficacy OF 5-Azacitidine And Bevacizumab In Advanced Renal Cell Carcinoma

Inclusion Criteria

Inclusion Criteria

- Age > 18 years old

- ECOG Performance Status 0, 1 or 2

- Adequate bone marrow, liver and renal function as assessed by the following:

- Hemoglobin > 9.0 g/dl

- Absolute neutrophil count(ANC)>1,500/mm3

- Platelet count >100,000/mm3

- Total bilirubin < 1.5 times ULN

- ALT and AST < 2.5 times the ULN (< 5 x ULN for patients with liver involvement)

- Creatinine < 1.5 times ULN

- Women of childbearing potential must have a negative serum pregnancy test performed
within 7 days prior to start of treatment.

- Women of childbearing potential and men must agree to use adequate contraception
(barrier method of birth control) prior to study entry and for duration of study. Men
should use adequate birth control for at least 3 months after the last administration
of Bevacizumab.

- Ability to understand and willingness to sign written informed consent. A signed
informed consent must be obtained prior to any study specific procedures.

- Patients not on anticoagulation must have an INR < 1.5 or a PT/PTT within normal
limits. Patients receiving anti-coagulation treatment with an agent such as warfarin
or heparin may be allowed to participate. For patients on warfarin, the INR should
be measured prior to initiation of treatment and monitored at least weekly, or as
defined by the local standard of care, until INR is stable.

- Must have histologically or cytologically confirmed renal cell carcinoma which is
metastatic (M1). Patients with unresectable primary tumors (but MO) are eligible.

- Must have measurable disease, defined as at least 1 lesion that can be accurately
measured in at least 1 dimension. Soft tissue disease that has been radiated in the
2 months prior to registration is not assessable as measurable disease. Soft tissue
disease within a prior radiation field must have progressed to be considered
assessable. X-rays, scans or physical examinations used for tumor measurement must
have been completed within 28 days prior to registration. X-rays, scans or physical
examinations for non-measurable disease must have been completed within 42 days prior
to registration.

- Patients with metastatic disease who have a resectable primary tumor and deemed a
surgical candidate may have undergone resection and have recovered from surgery. At
least 28 days must have elapsed since surgery and must have recovered from any
adverse effects of surgery.

- Urine protein must be screened by urine analysis for Urine Protein Creatinine (UPC)
ratio. For UPC ratio > 0.5, 24-hour urine protein must be obtained and the level must
be < 1,000mg for patient enrollment. The urine protein used to calculate the UPC
ratio must be obtained within 28 days prior to registration. NOTE: UPC ratio of spot
urine is an estimation of the 24-hour urine protein excretion - a UPC ratio of 1 is
roughly equivalent to a 24-hour urine protein of 1gm. UPC ratio is calculated using
one of the following formulas: [urine protein]/[urine creatinine] - if both protein
and creatinine are reported in mg/dL

- May have received prior immunotherapy with either interferon (IFN) and/or
Interleukin-2 (IL-2) or the combination of IFN/IL2 or prior chemotherapy (ie,
gemcitabine and capecitabine).

- Must have failed at least 1 prior biologic agent (sunitinib, sorafenib, or
temsorlimus). No limit on the number of prior therapies.

- At least 14 days must have elapsed since the last treatment. Must have recovered
from any adverse effects of prior therapy.

- May have received prior radiation therapy. At least 21 days must have elapsed since
completion of prior radiation therapy. Must have recovered from all associated
toxicities at the time of registration.

- Pregnant or nursing women not eligible because of potential teratogenic side effects
of 5-azacitidine and bevacizumab on the developing fetus or nursing infant. Women
and men of reproductive potential must have agreed to use an effective contraceptive
method.

- Patients with a history of allergic reactions attributed to compounds of similar
chemical or biologic composition to 5-azacitidine or bevacizumab are not eligible.

- Involvement in correlative studies must be offered to all patients but is not
required.

- No other prior malignancy is allowed except for the following: adequately treated
basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
Stage I or II cancer from which patient is currently in complete remission, or any
other cancer from which patient has been disease-free for 2 years.

- Must be informed of the investigational nature of this study and must sign and give
written informed consent in accordance with institutional and federal guidelines.

Exclusion Criteria

- Cardiac disease: Congestive heart failure > class II NYHA. Must not have unstable
angina (anginal symptoms at rest) or new onset angina (began within the last 3
months) or myocardial infarction within the past 6 months.

- Known brain metastasis. Patients with neurological symptoms must undergo a CT
scan/MRI of brain to exclude brain metastasis.

- Patients who have received prior bevacizumab are eligible for phase I portion of
study but ineligible for phase II study.

- Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy.

- Uncontrolled hypertension defined as systolic blood pressure > 150 mmHg or diastolic
pressure > 90 mmHg, despite optimal medical management.

- Known human immunodeficiency virus (HIV) infection or chronic Hepatitis B or C.

- Active clinically serious infection > CTCAE Grade 2.

- Thrombosis or embolic events such as cerebrovascular accident including transient
ischemic attacks within the past 6 months. Patients with tumor related IVC
thrombosis are eligible.

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

- Major surgery, open biopsy or significant traumatic injury within 4 weeks of first
study drug.