Topotecan, Cisplatin and Bevacizumab for Recurrent/Persistent Cervical Cancer

Inclusion Criteria:

* Recurrent or persistent squamous, adenosquamous or adenocarcinoma of the uterine cervix not amenable to curative treatment with surgery and/or radiotherapy
* No prior therapy (radiation, chemotherapy, hormonal therapy or immunotherapy) for recurrence or persistence. May have received platinum in combination with radiation as part of up-front treatment or adjuvant treatment
* Must have measurable disease as defined by RECIST criteria
* Must have at least one "target lesion" to assess response
* Performance status of 0 or 1
* Patients with ureteral obstruction must undergo stent or nephrostomy tube placement prior to study entry
* At least 4 weeks must have elapsed since prior treatment
* Age \>= 18 years
* Patients of childbearing potential must have a negative pregnancy test, use effective means of contraception
* Signed informed consent
* Bone marrow function: ANC \>= 1500/ul; platelets \>= 100,000 /ul
* Renal function: creatinine \<= 1,5 X ULN (if \> 1.5 creatinine clearance must be \> 60 ml/min)
* Hepatic function: bilirubin \<= 1.5 X ULN, AST and alkaline phosphatase \<= 2.5 X ULN
* Neurologic function: neuropathy \< CTC grade 1
* Coagulation: PT INR \<= 1.5

Exclusion Criteria:

* Evidence of sepsis or severe infection
* Prior therapy for recurrence
* Patients with serious, non-healing wound, ulcer or bone fracture
* Patients with history or evidence of nervous system disease, including primary brain tumor, brain metastases, seizure not controlled with standard medical therapy, CVA, stroke, TIA or subarachnoid hemorrhage within 6 months of 1st date of treatment on study
* Patients with history of other invasive malignancy (treatment within last 5 years) other than non-melanoma skin cancer
* Patient with clinically significant cardiovascular disease defined as:
* Inadequately controlled hypertension (systolic \> 150 and/or diastolic \> 100 on antihypertensive medications); prior history of hypertensive crisis or hypertensive encephalopathy
* Unstable angina within 6 months of enrollment
* NYHA Grade II or greater congestive heart failure
* Serious cardiac arrythmia requiring medication
* Grade 2 or greater peripheral vascular disease; claudication within 6 months
* History of myocardial infarction within 6 months
* Previously diagnosed coagulopathy, disseminated intravascular coagulopathy, immune thrombocytopenia purpura, thrombotic thrombocytopenia purpura or tumor involving major vessels
* Significant vascular disease: aortic aneurysm, aortic dissection
* Active thromboembolic disease: pulmonary embolism, deep venous thrombosis
* Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to day 1 of study; anticipation of need for major surgical procedure during course of the study
* Minor surgical procedure other than central venous access placement, within 7 days prior to day 1 of study
* Patients with proteinuria - patients with urine protein of 1+ on dipstick or \>=30 mg/dl at baseline should undergo UPCR; patients with UPCR of \>=1.0 should be excluded
* Patients who are pregnant or lactating
* No prior investigational agent within 30 days or planned participation in an experimental drug study
* Patients whose circumstances do not permit completion of study or required follow-up
* Prior therapy with bevacizumab or topotecan. Prior platinum therapy allowed as part of initial treatment
* History of abdominal fistula, GI perforation or intra-abdominal abscess within 6 months prior to study enrollment.
* Known hypersensitivity to any component of bevacizumab