Phase I/II Trial of Alectinib and Bevacizumab in Patients With Advanced, Anaplastic Lymphoma Kinase (ALK)-Positive, Non-Small Cell Lung Cancer

This research study is evaluating two drugs, alectinib and bevacizumab, as possible treatments for Advanced Non-Small Cell Lung Cancer (NSCLC).

This is a Phase I/II clinical trial. * A Phase I clinical trial tests the safety of an investigational intervention and also tries to define the appropriate dose(s) of the investigational intervention to use for further studies. * Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. * "Investigational" means that the intervention is being studied. * In this research study, the investigators are investigating the combination of two study drugs: alectinib and bevacizumab. The FDA (the U.S. Food and Drug Administration) has not approved alectinib as a treatment for any disease. It has been found that some people with NSCLC have a change (mutation) in a certain gene called the anaplastic lymphoma receptor tyrosine kinase (ALK) gene. This mutated gene helps cancer cells grow. \-- Alectinib belongs to a class of drugs designed to inhibit ALK. This drug has been used in other research studies. Information from those other research studies suggests that alectinib may be effective in killing cancer cells that have changes in ALK. Only participants with changes in the ALK gene will be allowed to participate in this study. In this research study, Alectinib will be combined with Bevacizumab. -- Bevacizumab (also called Avastin) works by slowing or stopping the growth of cells in cancer tumors by decreasing the blood supply of the tumors. If blood supply is decreased, oxygen and nutrients that are needed for tumor growth are decreased. The FDA has approved Bevacizumab as a treatment option for your disease The purpose of this study is to test the safety of Alectinib and Bevacizumab. The investigators will also determine how effective this combination is in participants with advanced, ALK-positive NSCLC with a focus on participants with brain metastases. In the phase I portion of the study, a 3 + 3 dose de-escalation design was to determine the recommended phase II dose (RP2D) of alectinib and bevacizumab. Three patients will be treated per cohort for one cycle (21 days per cycle) beginning with dose level 1 cohort. * Dose level 1 (starting dose) = Alectinib 600mg twice daily orally (PO), and Bevacizumab 15 mg/kg administered intravenously (IV) every 3 weeks. \-- Dose level 1 was selected based on the individual RP2Ds for each medication and anticipation for minimal overlapping toxicities. * Dose level -1 = Alectinib 600mg twice daily orally (PO),and Bevacizumab 7.5 mg/kg administered intravenously (IV) every 3 weeks. * Dose level -2 = Alectinib 450mg twice daily orally (PO), and Bevacizumab 7.5 mg/kg administered intravenously (IV) every 3 weeks. DLTs were defined as adverse events (AEs) occurring within the first cycle of treatment (21 days) attributed to the study drugs, and grade 3 or higher according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. If no DLTs are observed with dose level 1 cohort, we will enroll an additional 3 participants (6 total) to the same cohort and proceed with the phase II portion of the study if one or less experience a DLT. In any other dose level cohort, if one of three patients experiences a DLT, another 3 patients will be treated at the same dose level for one cycle. If no additional DLTs are observed, we will proceed with the phase II portion of the trial. If more than one of 3 patients develops a DLT in any cohort, another 3 patients will be treated in the next lowest dose cohort. The RP2D for the combination of alectinib and bevacizumab was defined as either (i) the highest dosage cohort in which less than a third of patients experienced a DLT, or (ii) alectinib at the previously defined RP2D as a single agent (600 mg twice daily) plus bevacizumab at the highest tolerated dose investigated for the indication (15 mg/kg every 21 days), whichever was the lower dose. In the phase II portion of the study, all patients received alectinib plus bevacizumab at the RP2D determined in the phase I portion. Cycles were 21 days long. Treatment was continued until there was evidence of progressive disease, death, or unacceptable toxicity. Patients were allowed to continue study drugs beyond progression if deemed clinically beneficial at the investigator's discretion. Intra-patient dose modification of bevacizumab was not permitted.