Vincristine Sulfate, Topotecan Hydrochloride, and Cyclophosphamide With or Without Bevacizumab in Treating Young Patients With Refractory or First Recurrent Extracranial Ewing Sarcoma

Exclusion Criteria

• •Fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy
• •At least 1 week since prior therapy with a biologic agent or growth factor
• •Patients must have histological verification of the malignancy at original diagnosis
• •Histological confirmation of relapse is highly recommended but not mandatory
• •Prior initial therapy with topotecan hydrochloride is allowed as long as \> 2 years have elapsed since the initial diagnosis of Ewing sarcoma
• •Prior therapy with cyclophosphamide or vincristine is allowed
• •Minor surgical procedures (e.g., biopsies) for limited purposes of tissue retrieval allowed
• •Minor procedures include indwelling IV catheter placement and needle biopsy for diagnostic purposes
• •For minor surgeries, patients should not receive the first planned dose of bevacizumab until the wound is healed and 7 days have elapsed
• •At least 6 months since prior craniospinal radiotherapy or radiotherapy to \>= 50% of the pelvis
• •At least 3 months since prior autologous stem cell transplantation (SCT)
• •Platelet count \>= 75,000/μL (transfusion independent)
• •Hemoglobin \>= 8.0 g/dL (may receive RBC transfusions)
• •Direct bilirubin =\< 1.5 times upper limit of normal (ULN) for age
• •Creatinine clearance or radioisotope GFR \>= 70 mL/min OR serum creatinine normal for age
• •Hypertension must be well controlled on stable doses of medication for \>= 2 weeks prior to enrollment
• •Negative pregnancy test
• •Female patients who are lactating must agree to stop breast-feeding
• •II) The patient has no active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices)
• •Shortening fraction \> 28% OR ejection fraction \> 50%
• •Recovered from any prior surgical procedure
• •Sexually active patients of childbearing potential must agree to use effective contraception
• •Radiological or clinical evidence for parenchymal brain metastases or neuro axis involvement
• •Documented, chronic nonhealing wound, ulcer, or significant traumatic injury (those with bone fractures, including pathological fractures, or requiring surgical intervention) within the past 28 days
• •Other bone complications
• •Deep venous thrombosis (including pulmonary embolism) within the past 3 months
• •Recent (i.e., within 6 months) arterial thromboembolic events, including transient ischemic attack or cerebrovascular accident
• •History of myocardial infarction, severe or unstable angina, or peripheral vascular disease Prior bevacizumab
• •Radiotherapy or surgery for local control of recurrent disease concurrently with bevacizumab (bevacizumab must be held if radiotherapy or surgery is required)
• •Radiotherapy to localized painful lesions is allowed, provided \>= 1 measurable lesion is not irradiated
• •Radiotherapy for local metastatic tumor control allowed after the first 2 courses of therapy
• •Other cancer chemotherapy or immunomodulating agents
• •Steroid use is allowed
• •Prior allogeneic SCT