Bevacizumab, Combination Chemotherapy, and Radiation Therapy in Treating Patients Undergoing Surgery For Locally Advanced Pancreatic Cancer

You may be eligible if

• DISEASE CHARACTERISTICS:
• Histologically confirmed adenocarcinoma of the pancreas
• * Resectable, marginally resectable, or unresectable disease determined by one of the following:
• * Contrast-enhanced helical-CT scan
• * Endoscopic ultrasound with biopsy (in patients who do not have metastatic or grossly unresectable disease)
• * Dedicated pancreatic MRI
• * Tumor must be locally advanced or potentially resectable, as determined by one of the following:
• * Abutment of the portal or superior mesenteric veins, hepatic or superior mesenteric artery
• * Extension to the origin of gastroduodenal artery
• * Occlusion of the superior mesenteric vein for \< 2 cm
• Measurable disease, defined as ≥ 1 lesion that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded) as ≥ 20 mm by conventional techniques or ≥ 10 mm by spiral CT
• * Marker elevation alone not allowed as justification for study entry
• Formalin-fixed, paraffin-embedded tumor tissue specimens from prior biopsy or surgical resection allowed for correlative studies
• No known brain metastases or tumor metastatic to the peritoneum, liver, or other organs
• PATIENT CHARACTERISTICS:
• ECOG performance status 0-1
• ANC ≥1,500/mm³
• Platelet count ≥ 100,000/mm³
• AST and ALT ≤ 2.5 times upper limit of normal (ULN)
• Creatinine \< 1.5 times ULN
• Bilirubin \< 2.0 mg/dL (≤ 10 mg/dL for patients with biliary obstruction by tumor)
• * A biliary stent ≥ 9F or biliary bypass is required before treatment if there is biliary obstruction by tumor
• Urine protein:creatinine ratio ≤ 1.0
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No significant traumatic injury within the past 28 days
• No serious non-healing wounds, ulcers, or bone fractures
• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 6 months
• No myocardial infarction, unstable angina, or cerebrovascular accident within the past 6 months
• No NYHA class II-IV congestive heart failure
• * Class II defined as symptoms of fatigue, dyspnea or other symptoms with ordinary physical activity
• No clinically significant peripheral vascular disease
• Pre-existing hypertension allowed, provided that the patient is receiving a stable antihypertensive regimen and has a blood pressure ≤ 150/100 mm Hg at the time of enrollment
• Must have adequate oral intake of \> 1500 calories/day and be able to maintain hydration OR have access for supplemental enteral feeding (nasoenteral tube, feeding jejunostomy, or percutaneous endoscopic gastrostomy tube)
• PRIOR CONCURRENT THERAPY:
• No prior chemotherapy or radiotherapy for pancreatic cancer
• More than 28 days since prior and no anticipated need for concurrent major surgical procedures
• More than 7 days since prior minor surgical procedures such as laparoscopy, fine needle aspirations, or core biopsies
• No treatment plan requiring treatment of \> 50% of the liver at a dose \> 30 Gy or \> 50% of the total kidney volume at a dose \> 18 Gy
• No concurrent combination antiretroviral therapy for HIV-positive patients
• No other concurrent investigational agents
• No oral or parenteral anticoagulation unless patients is receiving a stable dose of anticoagulant