Pemetrexed, Carboplatin, and Bevacizumab as First-Line Therapy in Treating Older Patients With Stage IIIB or Stage IV Non-Small Cell Lung Cancer

DISEASE CHARACTERISTICS:

* Histologically or cytologically confirmed nonsquamous cell non-small cell lung cancer (NSCLC)

  * Stage IIIB (with pleural effusion) or IV disease
  * Squamous cell carcinomas not allowed

    * Adenosquamous histology allowed
* Clinically significant effusion (e.g., symptomatic pleural effusion or ascites) allowed provided it is drained before study treatment

  * No symptomatic pleural and/or peritoneal effusion (≥ grade 2 dyspnea, as defined by NCI CTCAE v3.0 criteria) that is not amenable to drainage
  * If effusion produces clinically significant measurable objective changes, such as hypoxia or estimated volume \> 500 mL, effusion should be drained even if asymptomatic
* Measurable disease, defined as ≥ 1 lesion with longest diameter ≥ 2.0 cm by conventional techniques or ≥ 1.0 cm by spiral CT scan

  * If the sole site of disease is in a previously irradiated field, must have evidence of disease progression/recurrence within the irradiated field OR presence of a new lesion outside the irradiated field
* No symptomatic, untreated, or uncontrolled CNS metastases

  * CNS metastases that were previously treated with whole brain radiotherapy (WBRT) allowed
* Willing to enroll in NCCTG-N0392

PATIENT CHARACTERISTICS:

* ECOG performance status 0-1
* Life expectancy ≥ 12 weeks
* ANC ≥ 1,500/mm³
* Platelet count ≥ 100,000/mm³
* Hemoglobin ≥ 9 g/dL
* Total bilirubin ≤ 1.5 times upper limit of normal (ULN) OR direct bilirubin normal
* AST and ALT ≤ 3 times ULN (≤ 5 times ULN if liver has tumor involvement)
* Creatinine clearance ≥ 45 mL/min
* Not pregnant or nursing
* Fertile patients must use effective contraception during and for 3 months after completion of study treatment
* Able to take folic acid, vitamin B\_12 supplementation, or dexamethasone
* Able to complete questionnaire(s) alone or with assistance
* Willing to provide biologic specimens as required by the study
* Willing to return to NCCTG participating center for follow-up
* No clinically significant infection
* No serious, nonhealing wounds, ulcers, or bone fractures
* No seizure disorder
* No second primary malignancy within the past 5 years, except for any of the following:

  * Carcinoma in situ of the cervix
  * Nonmelanomatous skin cancer

    * History of melanoma allowed only if diagnosed and definitively treated ≥ 5 years ago with no subsequent evidence of recurrence
  * Low-grade (Gleason score ≤ 6) localized prostate cancer (no nodal involvement)
  * Previously treated stage I breast cancer
* No concurrent severe and/or uncontrolled medical condition, including any of the following:

  * Hypertension, labile hypertension, or history of poor compliance with antihypertensive medication
  * Angina pectoris
  * Congestive heart failure within the past 3 months, unless ejection fraction \> 40%
  * Myocardial infarction within the past 6 months
  * Cardiac arrhythmia
  * Diabetes mellitus
  * Interstitial pneumonia or extensive, symptomatic interstitial fibrosis of the lung
  * Active or recent history of hemoptysis \> ½ teaspoon per event
  * Ongoing or active infection
  * Psychiatric illness/social situation that would limit compliance with study requirements
* No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 12 months
* No diverticulitis within the past 12 months
* No stroke within the past 6 months
* No significant traumatic injury within the past 8 weeks
* Not at greater than normal risk of bleeding

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
* No prior radiotherapy to \> 25% of bone marrow
* More than 2 weeks since prior radiotherapy and recovered (alopecia allowed)
* At least 2 weeks since prior WBRT
* At least 3 days since prior gamma knife radiosurgery (without WBRT) for brain metastases
* More than 4 weeks since prior administration of live or attenuated viral vaccine
* More than 8 weeks since prior major surgery (e.g., laparotomy) or open biopsy (\> 4 weeks since minor surgery)

  * Insertion of a vascular access device allowed
* No prior chemotherapy or systemic therapy for advanced lung cancer, except neoadjuvant or adjuvant chemotherapy
* No NSAID's 2 days prior to (5 days for long-acting NSAID's), the day of, and 2 days following protocol treatment
* More than 12 months since prior neoadjuvant therapy, adjuvant therapy, systemic chemotherapy, chemoradiotherapy, immunotherapy, or biologic therapy
* No concurrent anticoagulants

  * Low-dose warfarin or heparin for deep venous thrombosis prophylaxis allowed