FOLFOX With Bevacizumab in Metastatic or Unresectable Gastroesophageal and Gastric Cancer

Inclusion Criteria:

* Histologically or cytologically documented recurrent, metastatic or unresectable gastroesophageal (Siewert type I, II, III) or gastric adenocarcinoma with measurable or assessable non-measurable disease (RECIST criteria).
* If recurrent or metastatic disease is not histologically confirmed, then documentation by a second radiographic procedure (i.e., PET scan or MRI in addition to CT scan) is required. If the imaging procedure does not confirm recurrent or metastatic disease, biopsy confirmation is required
* 12 months since completion of any prior neoadjuvant or adjuvant therapy (chemotherapy or radiotherapy) for potentially resectable gastroesophageal or gastric adenocarcinoma.
* \>4 weeks since major surgery.
* ECOG Performance Status: 0-1
* Life expectancy \>12 weeks
* Laboratory parameters as follows: absolute neutrophil count ≥1,500/uL, platelet count ≥100,000/uL, hemoglobin ≥9 g,/dL, creatinine \<1.5 X ULN or estimated GFR \>30 ml's/min, urinalysis \<2+ protein, baseline proteinuria \<1000 mg/d or urine protein/creatinine ratio \<1, bilirubin \<2 X ULN, PT (INR) \<1.5 if patient not on anticoagulation, negative pregnancy test in women of childbearing age
* Hypertension must be well controlled (\<160/90)
* Paraffin block or slides must be available
* Patients on full-dose anticoagulants must be on a stable dose of warfarin and have an in-range INR or be on a stable dose of low molecular weight heparin.

Exclusion Criteria:

* prior treatment for recurrent, metastatic, or unresectable gastroesophageal or gastric adenocarcinoma
* other concurrent anticancer therapy
* other malignancy within past three years except basal cell carcinoma of the skin, cervical carcinoma in situ, or nonmetastatic prostate cancer known central nervous system metastases or carcinomatous meningitis.
* interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung.
* \> grade 2 sensory peripheral neuropathy.
* uncontrolled seizure disorder, active neurological disease, or known CNS disease.
* significant cardiac disease, including the following: unstable angina, New York Heart Association class II-IV congestive heart failure, myocardial infarction within six months prior to study enrollment.
* history of hypertensive crisis or hypertensive encephalopathy
* abdominal fistula, gastrointestinal bleeding, or intra-abdominal abscess within the 6 months prior to study enrollment.
* core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to study enrollment.
* major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to study enrollment or anticipation of need for major surgical procedure during the course of the study.
* recent arterial thrombotic events including stroke or TIA within 6 months prior to study enrollment.
* serious or non-healing wound, ulcer or bone fracture.
* active bleeding or pathological condition that carries a high risk of bleeding (e.g., tumor involving major vessels or known varices).