Neoadjuvant Therapy for Ovarian Cancer

Inclusion Criteria

• Patients must have Suspected Federation of Gynecology and Obstetrics (FIGO) stage III or IV disease.
• Cytologic or histologic diagnosis of a carcinoma felt by the investigator to be compatible with epithelial cancer of the ovary, fallopian tube, or primary peritoneum
• Patients must have a Performance Status of 0, 1 or 2.
• Patients with prior anthracycline exposure must have a baseline multigated acquisition scan (MUGA) or echocardiogram prior to study entry.
• Patients must have adequate:
• Bone marrow function: Absolute neutrophil count (ANC) greater than or equal to 1500/υl, equivalent to Common Toxicity Criteria for Adverse Events v3.0 (CTCAE) Grade 1. This ANC cannot have been induced or supported by granulocyte colony stimulating factors.
• Platelets greater than or equal to 100,000/υl (CTCAE Grade 0-1).
• Hematocrit > 21%.
• Renal function: Creatinine 140 mm Hg or diastolic > 90 mm Hg.
• Myocardial infarction or unstable angina within 6 months of day 1 prior to registration.
• New York Heart Association (NYHA) Grade II or greater congestive heart failure.
• Serious cardiac arrhythmia requiring medication. This does not include atrial fibrillation.
• CTCAE Grade 3 or greater peripheral vascular disease.
• History of CVA within six months.
• Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibodies including hypersensitivity to any component of bevacizumab
• Patients with clinically significant proteinuria. Urine protein should be screened by urine protein-creatinine ratio (UPCR). The UPCR has been found to correlate directly with the amount of protein excreted in a 24 hour urine collection. Specifically, a UPCR of 1.0 is equivalent to 1.0 grams of protein in a 24 hour urine collection. Obtain at least 4 ml of a random urine sample in a sterile container (does not have to be a 24 hour urine). Send sample to lab with request for urine protein and creatinine levels (separate requests). The lab will measure protein concentration (mg/dL) and creatinine concentration (mg/dL). The UPCR is derived as follows: protein concentration (mg/dL)/creatinine (mg/dL). Patients must have a UPCR < 1.0 to allow participation in the study.
• Patients with hypertensive crises or hypertensive encephalopathy
• History of hemoptysis (≥ ½ teaspoon of bright red blood per episode) within 1 month prior to day 1.
• Patients with or with anticipation of a non-study related invasive procedure defined as followed:
• Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to the first date of bevacizumab.
• Major non-study related surgical procedure anticipated during the course of the study.
• Core biopsy within 7 days prior to first date of bevacizumab.
• Patients with a Performance Status of Grade 3 or 4 are not eligible.
• Patients who are pregnant or nursing. Subjects of child-bearing age have to use effective means of contraception.
• Patients under the age of 18.
• Patients who have received prior therapy with any anti-VEGF drug, including bevacizumab. Vascular endothelial growth factor (VEGF)
• Patients with human immunodeficiency virus (HIV).
• Patients with medical history or conditions not otherwise previously specified which in the opinion of the investigator should exclude participation in this study. The investigator should consult the Study Chair.