Bevacizumab and Gemcitabine Combined With Either Cetuximab or Erlotinib in Treating Patients With Advanced Pancreatic Cancer

You may be eligible if

• Histologically or cytologically confirmed adenocarcinoma of the pancreas
• * Advanced disease
• * Patients with locally advanced disease must have disease that extends outside the boundaries of a standard radiation port
• Not amenable to curative surgery or radiotherapy
• Measurable disease
• * At least 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan
• * Pleural effusions and ascites are not considered measurable lesions
• No CNS disease, including primary brain tumors or brain metastasis
• No tumor invasion into the duodenum
• Performance status - ECOG 0-2
• More than 3 months
• Absolute neutrophil count ≥ 1,500/mm\^3
• Platelet count ≥ 100,000/mm\^3
• WBC ≥ 3,000/mm\^3
• No history of bleeding diatheses
• Bilirubin ≤ 1.5 times upper limit of normal (ULN)
• SGOT and SGPT ≤ 2.5 times ULN (5 times ULN if liver metastases are present)
• INR ≤ 1.5 (≤ 3 for patients on warfarin)
• No esophageal varices
• Creatinine ≤ 1.5 mg/dL
• Creatinine clearance ≥ 60 mL/min
• Urine protein \< 1+
• 24-hour urine protein \< 500 mg
• No history of a recent cerebrovascular accident
• No clinically significant cardiovascular disease
• No uncontrolled hypertension
• No New York Heart Association class II-IV congestive heart failure
• No serious cardiac arrhythmia requiring medication
• No peripheral vascular disease ≥ grade II
• None of the following arterial thromboembolic events within the past 6 months:
• * Transient ischemic attack
• * Cerebrovascular accident
• * Unstable angina
• * Myocardial infarction
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for at least 3 months after study participation
• HIV negative
• No significant traumatic injury within the past 28 days
• No gastrointestinal tract disease resulting in an inability to take oral medication
• No allergic reactions to compounds similar to bevacizumab, cetuximab, or erlotinib (e.g., Chinese hamster ovary cell products or recombinant humanized antibodies)
• No serious or non-healing wound, ulcer, or bone fracture
• No active infection requiring antibiotics
• No other active malignancy within the past 5 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
• No prior bevacizumab or cetuximab
• No other prior vascular endothelial growth factor inhibitors
• No prior gemcitabine
• No prior cytotoxic chemotherapy for metastatic disease
• At least 4 weeks since prior adjuvant chemotherapy (6 weeks for mitomycin or nitrosoureas)
• At least 4 weeks since prior radiotherapy
• * Must have a site of measurable disease outside the radiation port
• No prior surgical procedure affecting absorption
• More than 28 days since prior major surgical procedure or open biopsy
• More than 7 days since prior core biopsy
• No concurrent major surgical procedures
• No prior erlotinib
• No other prior epidermal growth factor receptor inhibitors
• At least 30 days since prior investigational drugs
• More than 1 month since prior thrombolytic agents
• Concurrent warfarin or low molecular weight heparin allowed provided the following criteria are met:
• * Currently therapeutic on a stable dose
• * INR target range ≤ 3
• * Patients undergo weekly INR testing
• * No evidence of active bleeding or pathological condition that carries high risk of bleeding (e.g., tumor invading adjacent organs or esophageal varices)
• No concurrent chronic daily therapy with aspirin (\> 325 mg/day) or nonsteroidal anti-inflammatory medications known to inhibit platelet function
• No other concurrent antiplatelet medications
• No concurrent combination antiretroviral therapy for HIV-positive patients
• No other concurrent anticancer therapies or agents
• No other concurrent investigational drugs