Treatment Study Using Bevacizumab for Patients With Adrenocortical Carcinoma

Inclusion Criteria:

* Subjects must provide written informed consent
* Subjects must be 18 years of age or older
* Subjects must have histologically confirmed ACC by the Department of Pathology at Dartmouth-Hitchcock Medical Center
* Subjects must have inoperable disease
* This is a first and/or second line study. Patients must have completed only one or fewer regimes of systemic therapy. They may have received one prior systemic therapy either: a) mitotane, or b)chemotherapy, or c) experimental therapy, or d) concurrent chemotherapy and mitotane, or e) no prior systemic therapy
* Subjects must have a life expectancy of three or more months
* If subjects have received some form of systemic therapy (e.g. chemotherapy or mitotane), they should have completed that systemic therapy at least 28 days before beginning Bevacizumab
* All subjects of child-bearing potential(men and women) must agree to the use of effective means of contraception

Exclusion Criteria:

* Other co-existing malignancies or malignancies diagnosed within the last 5 years wtih the exception of basal cell carcinoma or cervical cancer in situ
* Any unresolved chronic toxicity greater than CTC grade 2 from previous anticancer therapy (except alopecia)
* absolute neutrophil counts less than 1.5 x l,000,000,000/liter, or platelets less than 20.0 x 1,000,000,000/liter
* As judged by the investigator, any evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory,cardiac, hepatic, or renal disease)
* Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the subject to participate in the trial
* Prior therapy with two or more systemic therapy regimes. In other words if a patient is seeking third line therapy or later than third line therapy he is ineligible for this study
* Current, recent(within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study other than a Genentech- sponsored Bevacizumab cancer study
* Prior use of Bevacizumab or any other anti-VEGF therapies
* Known hypersensitivity to Bevacizumab
* Inadequately controlled hypertension (defined as systolic blood pressure of \>150 mm Hg and/or diastolic blood pressure \>100 mm Hg on anti- hypertensive medications
* Any prior history of hypertensive crisis or hypertensive encephalopathy
* Unstable angina
* New York Heart Association (NYHA)Grade II or greater congestive heart failure
* History of myocardial infarction within 6 months
* History of stroke or transient ischemic attack at any time prior to study enrollment
* Clinically significant peripheral vascular disease
* Evidence of bleeding diathesis or coagulopathy
* Presence of central nervous system or brain metastases
* Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 0, anticipation of need for major surgical procedure during the course of the study
* Core biopsies or other minor surgical procedures, excluding placement of a vascular access device, within 7 days prior to Day 0
* Pregnant (positive pregnancy test) or lactating
* Women who are fertile and not willing to practice abstinence or an adequate form of contraception (i.e. use or oral contraceptives, intrauterine devices or barrier protection)
* Urine protein: creatinine ratio \> 1.0 at screening -History of abdominal fistula, gastrointestinal perforation, or intr- abdominal abcess within 6 months prior to Day 0
* Serious, non-healing wound, ulcer, or bone fracture
* Lung lesions of any etiology(malignant or nonmalignant) in close proximity to a major vessel
* Cavitary lung lesions (to prevent episodes of potentially life-threatening hemoptysis)
* History of hemoptysis (defined as bright red blood of 1/2 teaspoon or more)
* Inability to comply with study and/or follow-up procedures