Bevacizumab in Reducing CNS Side Effects in Patients Who Have Undergone Radiation Therapy to the Brain for Primary Brain Tumor, Meningioma, or Head and Neck Cancer

Inclusion Criteria:

• No evidence of bleeding diathesis or coagulopathy

• Fertile patients must use effective contraception during and for >= 2 months after completion of study therapy

• No diarrhea >= grade 1

• Histologically confirmed primary brain neoplasm, meningioma, or head and neck cancer [WHO grade 2 or 3 disease--no WHO grade 4 primary brain neoplasms (i.e., glioblastoma or gliosarcoma)]

• Patients with head and neck cancer must not have any of the following:

• Evidence of metastatic disease

• Evidence of tumor invasion to major vessels (e.g., the carotid)

• History of bleeding related to tumor or radiotherapy during or after completion of radiotherapy

• Must have undergone cranial irradiation

• Must have radiographic evidence to support the diagnosis of radiation necrosis and/or surgical biopsy evidence of necrosis without tumor within the past 2 months

• Must have evidence of progressive neurologic signs or symptoms appropriate to the location of the radiation necrosis

• No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days

• No significant traumatic injury within the past 28 days

• No evidence of active CNS hemorrhage

• Karnofsky performance status 60-100%

• No clinically significant cardiovascular disease, including any of the following:

• Inadequately controlled hypertension (i.e., systolic BP > 140 mm Hg and/or diastolic BP > 90 mm Hg despite antihypertensive medication)

• Large vessel cerebrovascular accident within the past 6 months

• Myocardial infarction or unstable angina within the past 6 months

• No clinically significant cardiovascular disease, including any of the following:

• NYHA class II-IV congestive heart failure

• Serious or inadequately controlled cardiac arrhythmia

• Significant vascular disease (e.g., aortic aneurysm or history of aortic dissection)

• Clinically significant peripheral vascular disease

• At least 6 months since prior radiotherapy

• Platelet count > 75,000/mm^3

• Granulocyte count > 1,500/mm^3

• Creatinine < 1.0 times ULN

• AST < 2.5 times ULN

• Not pregnant or nursing

• Negative pregnancy test

• Prior chemotherapy for tumor allowed

• Prior tyrosine kinase inhibitors of VEGF receptor (VEGFR) allowed

• More than 28 days since prior and no concurrent major surgical procedure or open biopsy

• Concurrent dexamethasone allowed provided patient is on a stable dose for >= 1 week prior to study entry

• Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed provided the following criteria are met:

• In-range INR (usually between 2 and 3) and patient is on a stable dose of oral anticoagulant for 1 week or on a stable dose of low molecular weight heparin

• No active bleeding or pathological condition that carries a high risk of bleeding

• Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed provided the following criteria are met: No evidence of serious or nonhealing wound, ulcer, or bone fracture

• No concurrent chemotherapy or tyrosine kinase inhibitors of VEGFR

• No prior bevacizumab

• More than 7 days since prior core biopsy

• History of seizures allowed provided the patient is receiving anticonvulsant therapy

• Hemoglobin >= 9.0 g/dL

• Bilirubin =< 1.5 times upper limit of normal (ULN)

• No other concurrent investigational agents