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 < 1.0

      - If UPC > 0.5, 24-hour urine protein must be < 1,000 mg

   - Hearing loss primarily sensorineural in nature and requiring a hearing aid or
   intervention that interferes in a clinically significant way with activities of daily
   living allowed

   - Conductive hearing loss from tumor-related otitis media is allowed

   - No severe, active comorbidity, including any of the following:

      - Ongoing bleeding diathesis, hemorrhagic disorder, or coagulopathy within the past
      6 months

      - Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess
      within the past 6 months

      - Esophageal varices, nonhealing wound, nonhealing ulcer, or bone fracture within
      the past 6 months

      - Chronic obstructive pulmonary disease exacerbation or other respiratory illness
      requiring hospitalization or precluding study therapy within the past 30 days

      - Unstable angina and/or congestive heart failure or peripheral vascular disease
      requiring hospitalization within the past 12 months

      - Major medical or psychiatric illness that, in the opinion of the study
      investigator, would preclude study compliance

      - Active, untreated infection and/or acute bacterial or fungal infection requiring
      intravenous antibiotics

      - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

      - History of significant weight loss (> 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