PRIMARY OBJECTIVES:
I. To estimate the hazard of progression or death of each of the three arms relative to that of historical controls in patients with advanced or recurrent endometrial cancer.
SECONDARY OBJECTIVES:
I. To determine the nature, frequency, and maximum degree of toxicity as assessed by Common Terminology Criteria for Adverse Events (CTCAE) version (v)3.0 for each of the three arms.
II. To estimate the distribution of the duration of overall survival for each of the three arms.
III. To estimate the proportion of patients with measurable disease who have confirmed objective tumor responses by treatment.
TERTIARY OBJECTIVES:
I. Explore the associations between select biomarkers and progression-free survival as well as secondary measures of clinical outcome (overall survival, tumor response, or disease status if possible) in the context of histologic cell type and treatment.
IA. Somatic mutations in phosphatase and tensin homolog (PTEN)/ phosphoinositide-3-kinase (PI3K) and RAS pathway members by Sequenom mutational profiling and targeted sequencing of candidate genes.
IB. Microsatellite instability by analysis of five National Cancer Institute consensus microsatellite markers (BAT25, BAT26, D2S2123, D5S346, and D17S250) using the Applied Biosystems (ABI) Prism 3100 Genetic Analyzer.
IC. Copy number alterations (gains or losses) by array comparative genomic hybridization (aCGH).
ID. Tumor expression of PTEN and class III beta-tubulin using immunohistochemistry.
IE. Concentration of vascular endothelial growth factor (VEGF) in pre-cycle 1 plasma using an enzyme-linked immunosorbent assay.
II. Explore the relationship among the various biomarkers by histologic subtype and treatment.
III. Explore which combination of biomarkers and clinical covariates optimally predicts responsiveness and resistance to the three treatment arms.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive paclitaxel intravenously (IV) over 3 hours, carboplatin IV over 30 minutes, and bevacizumab\* IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE THERAPY: Patients receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
NOTE: \*Patients undergoing treatment post-surgery (=\< 12 weeks) receive bevacizumab beginning on course 2.
ARM II: Patients receive paclitaxel IV over 3 hours and carboplatin IV over 30 minutes on day 1 and temsirolimus\* IV over 30 minutes on days 1 and 8. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE THERAPY: Patients receive temsirolimus IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
NOTE: \*Patients undergoing treatment post-surgery (=\< 12 weeks) receive temsirolimus beginning on course 2.
ARM III: Patients receive ixabepilone IV over 1 hour, carboplatin IV over 30 minutes, and bevacizumab\* IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE THERAPY: Patients receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
NOTE: \*Patients undergoing treatment post-surgery (=\< 12 weeks) receive bevacizumab beginning on course 2.
After completion of study therapy, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
