Retarded Surgery Following Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

Inclusion Criteria:

1. Female patients ≥18 years.

2. Histologically confirmed epithelial ovarian cancer, fallopian tube carcinoma orprimary peritoneal carcinoma, high grade serous or endometrioïd, with the exceptionof mucinous, clear cell and carcinosarcoma histologies.

3. Performance status < 2 (see Appendix 2).

4. Documented International Federation of Gynecologic Oncology (FIGO 2014, Appendix 1)stage IIIB-IIIC-IVa unsuitable for complete primary cytoreductive surgery (confirmedby open laparoscopy or by laparotomy [not mandatory for stage IVA]).

5. Patient must be judged resectable after 3 courses of Neoadjuvant chemotherapy

6. Adequate bone marrow, liver and renal function to receive chemotherapy andsubsequently to undergo surgery:

• White blood cells (WBC) >3x109/L, absolute neutrophil count (ANC) ≥1,5x109/L,platelets (PLT) ≥100x109/L, hemoglobin (Hb) ≥9 g/dL,

• Serum creatinine <1.25 x upper normal limit (UNL) or creatinine clearance ≥ 30mL/min according to Cockroft-Gault formula or to local lab measurement, serumbilirubin <1.25 x UNL, AST(SGOT) and ALT(SGPT) <2.5 x UNL.

7. Signed informed consent obtained prior to any study-specific procedures.

8. Patient affiliated to, or a beneficiary of, a social security category

Exclusion Criteria:

1. Mucinous, clear cell , carcinosarcoma and low grade serous carcinomahistologies.

2. Synchronous or previous other malignancies within 3 years prior to starting studytreatment, with the exception of adequately treated non-melanomatous skin cancer orcarcinoma in situ (of the cervix or breast or other sites).

3. Patients with brain metastases, seizure not controlled with standard medicaltherapy, or history of cerebrovascular accident (CVA, stroke) or transient ischemicattack (TIA) or subarachnoid hemorrhage before 6 months from the enrollment on thisstudy.

4. Any other concurrent medical conditions contraindicating surgery or chemotherapythat could compromise the adherence to the protocol (including but not limited toimpaired cardiac function or clinically significant cardiac diseases, active oruncontrolled infections, HIV-positive patients on antiretroviral therapy,uncontrolled diabetes, cirrhosis, chronic active or persistent hepatitis, impairedrespiratory function requiring oxygen-dependence, serious psychiatric disorders).

5. Pregnant or breastfeeding women.