Carboplatin, Paclitaxel and Gemcitabine Hydrochloride With or Without Bevacizumab After Surgery in Treating Patients With Recurrent Ovarian, Epithelial, Primary Peritoneal, or Fallopian Tube Cancer

Inclusion Criteria:

• Patients enrolled after August 28, 2011 must be candidates for cytoreductive surgeryand consent to have their surgical treatment determined by randomization

• Patients must have histologic diagnosis of epithelial ovarian carcinoma, peritonealprimary or fallopian tube carcinoma, which is now recurrent

• Patients with the following histologic epithelial cell types are eligible: serousadenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma,undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma,transitional cell carcinoma, malignant Brenner's tumor, or adenocarcinoma nototherwise specified (N.O.S.)

• Patients must have had a complete response to front-line platinum-taxane therapy (atleast three cycles)

• A complete response to front-line chemotherapy must include: negative physical exam,negative pelvic exam and normalization of CA125, if elevated at baseline; althoughnot required, any radiographic assessment of disease status (e.g. CT, magneticresonance imaging [MRI], positron emission tomography [PET]/CT, etc) obtainedfollowing the completion of primary therapy should be considered negative fordisease

• All patients must have also had a treatment-free interval without clinical evidenceof progressive disease of at least 6 months from completion of front-linechemotherapy (both platinum and taxane); front-line therapy may have included abiologic agent (i.e. bevacizumab)

• Front-line treatment may include maintenance therapy following complete clinical orpathological response; however, maintenance cytotoxic chemotherapy must bediscontinued for a minimum of 6 months prior to documentation of recurrent disease;patients receiving maintenance biological therapy or hormonal therapy are ELIGIBLEprovided their recurrence is documented more than 6 months from primary cytotoxicchemotherapy completion (includes maintenance chemotherapy) AND a minimum 4 weekshas elapsed since their last infusion of biological therapy

• Patients must have clinically evident recurrent disease for the purpose of thisstudy

• Measurable disease (Response Evaluation Criteria in Solid Tumors [RECIST]) isdefined as at least one lesion that can be accurately measured in at least onedimension (longest dimension to be recorded); each lesion must be more than or equalto 20 mm when measured by conventional techniques, MRI or CT, or more than or equalto 10 mm when measured by spiral CT

• Absolute neutrophil count (ANC) greater than or equal to 1,500/mm^3, equivalent toCommon Toxicity Criteria for Adverse Events version (v)4.0 (CTCAE) grade 1

• Platelets greater than or equal to 100,000/mm^3 (CTCAE grade 0-1)

• Creatinine (non-isotope dilution mass spectrometry [IDMS]) =< 1.5 x institutionalupper limit normal (ULN), CTCAE grade 1

• Total bilirubin =< 1.5 ULN (CTCAE grade 1)

• Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) =< 2.5 times the upper limit of normal in the absence of liver metastasis; SGOT/AST < 5.0 times ULN in the presence of liver metastasis

• Alkaline phosphatase =< 2.5 times the upper limit of normal in the absence of livermetastasis; alkaline phosphatase < 5.0 times ULN in the presence of liver metastasis

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients must have aurine protein-to-creatinine ratio (UPCR) < 1.0 mg/dL

• This eligibility criterion does not apply to patients enrolled after August 28, 2011; patients who are not candidates for surgical cytoreduction are eligible forthe chemotherapy randomization; patients are not considered candidates for surgicalcytoreduction if complete cytoreduction in the estimation of the investigator isimpossible or a medical infirmity precludes exploration and debulking

• Patients must have met the pre-entry requirements as specified

• Patients must have signed an approved informed consent and authorization permittingrelease of personal health information

• Patients must have a Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2

Exclusion Criteria:

• Patients who have received more than one previous regimen of chemotherapy (maintenance is not considered a second regimen)

• Patients receiving concurrent immunotherapy, or radiotherapy

• Patients who have received prior radiotherapy to any portion of the abdominal cavityor pelvis are excluded

• Patients whom have already undergone secondary cytoreduction for recurrent diseaseare excluded

• Patients with a prior histologic diagnosis of borderline, low malignant potential (grade 0) epithelial carcinoma that was surgically resected and who subsequentlydeveloped an unrelated, new invasive epithelial ovarian or peritoneal primary cancerare eligible provided that they meet the criteria listed above

• Patients who require parenteral hydration or nutrition and have evidence of partialbowel obstruction or perforation

• Patients who have received prior chemotherapy for any abdominal or pelvic tumor (other than ovarian, fallopian tube, and primary peritoneal) are excluded

• Patients with synchronous primary endometrial cancer, or a past history of primaryendometrial cancer, are excluded, unless all of the following conditions are met:stage not greater than I-B; no more than superficial myometrial invasion, withoutvascular or lymphatic invasion; no poorly differentiated subtypes, includingpapillary serous, clear cell or other International Federation of Gynecology andObstetrics (FIGO) grade 3 lesions

• Patients with uncontrolled infection

• Patients with concurrent severe medical problems unrelated to the malignancy thatwould significantly limit full compliance with the study or expose the patient toextreme risk or decreased life expectancy

• Patients with >= grade 2 peripheral neuropathy

• Patients with a history of allergic reactions to carboplatin and/or paclitaxel orchemically similar compounds; patients with allergic (hypersensitivity) reactions tothese chemotherapeutic agents are NOT excluded IF they were successfully retreatedfollowing a desensitization program or protocol

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients with knownhypersensitivity to Chinese hamster ovary cell products or other recombinant humanor humanized antibodies

• Patients of childbearing potential, not practicing adequate contraception, patientswho are pregnant or patients who are nursing are not eligible for this trial; todate, no fetal studies in animal or humans have been performed; the possibility ofharm to a fetus is likely; bevacizumab specifically inhibits VEGF, which isresponsible for the formation of new blood vessels during development, andantibodies can cross the placenta; therefore, bevacizumab should not be administeredto pregnant women; in addition, there are unknown immediate and long-termconsequences of chemotherapy administration to these women; in addition, surgicalexploration as mandated by randomization during pregnancy may cause imminent mortalconsequences; further, it is not known whether bevacizumab is excreted in humanmilk; because many drugs are excreted in human milk, bevacizumab should not beadministered to nursing women; subjects will be apprised of the large potential riskto a developing fetus

• Patients with other invasive malignancies, with the exception of non-melanoma skincancer, who had (or have) any evidence of the other cancer present within the last 5years or whose previous cancer treatment contraindicates this protocol therapy

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients with activebleeding or pathologic conditions that carry high risk of bleeding such as a knownbleeding disorder, coagulopathy, or tumor involving major vessels

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients with ahistory or evidence upon physical examination of central nervous system (CNS)disease, including primary brain tumor, seizures not controlled with standardmedical therapy, any brain metastases or a history of stroke within 5 years of thefirst date of treatment on this study

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients withclinically significant cardiovascular disease; this includes:

• Patients with significant cardiac conduction abnormalities, i.e. PR interval > 0.24 seconds (sec) or 2nd or 3rd degree atrioventricular (AV) block

• Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mmHg

• Myocardial infarction, cardiac arrhythmia or unstable angina < 6 months priorto registration

• New York Heart Association (NYHA) grade II or greater congestive heart failure

• Serious cardiac arrhythmia requiring medication

• Grade II or greater peripheral vascular disease (exception: episodes ofischemia < 24 hours [hrs] in duration, that are managed non-surgically andwithout permanent deficit)

• History of cerebrovascular attack (CVA) within six months

• This criterion applies only to the patients enrolled before August 29, 2011 andthose enrolled after this date electing to receive bevacizumab; patients who havehad a major surgical procedure, open biopsy, dental extractions or other dentalsurgery/procedure that results in an open wound, or significant traumatic injurywithin 28 days prior to the first date of treatment on this study, or anticipationof need for major surgical procedure during the course of the study; patients withplacement of vascular access device or core biopsy within 7 days prior to the firstdate of treatment on this study

• Patients undergoing pre-treatment secondary cytoreduction will undergo therapy withbevacizumab on cycle #2

• Patients undergoing pre-treatment surgery for purposes other than cytoreduction mayalso participate provided they meet eligibility; patients randomized to armscontaining bevacizumab must wait a minimum of 28 days since that procedure to beginprotocol treatment; patients who undergo an uncomplicated port placement must wait aminimum of 7 days to begin protocol treatment