MITO 25.1: A randomized, molecular driven phase II trial of Carboplatin-Paclitaxel-Bevacizumab vs Carboplatin-Paclitaxel-Bevacizumab-Rucaparib vs Carboplatin-Paclitaxel-Rucaparib, selected according to HRD status, in patients with advanced (stage III B-C-IV) ovarian, primary peritoneal and Fallopian tube cancer preceded by a phase I dose escalation study on Rucaparib-Bevacizumab combination.

Prior treatment

• Prior gastrectomy or upper bowel removal, or any other gastrointestinal disorder or defect that would interfere with absorption of study drug;
• Received administration of strong CYP1A2 or CYP3A4 inhibitors ≤7 days prior to first dose of Rucaparib or have on-going requirements for these medications.
• Prior Anticancer treatment for ovarian cancer
• Inadequate recovery from any prior surgical procedure or having undergone any major surgical procedure within 3 weeks prior to randomization
• Concurrent treatment with immunosuppressive or investigational agents
• History or evidence of thrombotic or hemorrhagic disorders; including cerebrovascular accident (CVA) / stroke or transient ischemic attack (TIA) or subarachnoid haemorrhage within 6 months prior to the first study treatment);
• Clinically significant (i.e. active) cardiovascular disease, including: - Myocardial infarction or unstable angina within 6 months prior to the first study treatment; - New York Heart Association (NYHA) grade II or greater congestive heart failure (CHF); - Serious cardiac arrhythmia requiring medication (with the exception of atrial fibrillation or paroxysmal supraventricular tachycardia); - Peripheral vascular disease > grade 3 (i.e. symptomatic and interfering with activities of daily living requiring repair or revision);

Other illness

• Serious active infection requiring i.v. antibiotics at enrolment;
• Known hypersensitivity to any of the study drugs or excipients (including cremophor and hamster Ovary cell products);
• Known active HIV, hepatitis B or C infection;

Lab values

• Evidence of any other medical conditions (such as psychiatric illness, peptic ulcer, etc.), physical examination or laboratory findings that may interfere with the planned treatment, affect patient compliance or place the patient at high risk from treatment related complications;

Age

• Another primary malignancy except for: - Curatively treated non-melanoma skin cancer; - Breast cancer treated curatively ≥5 years ago, or other solid tumor treated curatively ≥5 years ago, without evidence of recurrence; - Synchronous endometrioid endometrial cancer (except for Stage 1A G1/G2);

Other

• Women who are pregnant or lactating
• Presence of brain or other central nervous system metastases, not adequately controlled by treatment

• Women aged >/= 18 years at the time of study inclusion
• Patients with newly diagnosed, histologically confirmed, high grade serous, high grade endometrioidFIGO stage IIIB-C-IV epithelial ovarian cancer, primary peritoneal cancer and / or Fallopian-tube cancer. Patients with mixed histology (carcinosarcoma) are eligible providing that high grade tumor represent more than 50% of the total histology; Stage III patients should have had one attempt at optimal debulking surgery (upfront or interval debulking). Stage IV patients must have had either a biopsy and/or upfront or interval debulking surgery;
• Archival tumor tissue available. At progression fresh biopsy is optional for patients willing to submit
• ECOG Performance Status of 0–1
• Adequate renal and hepatic function, defined as: - Total serum bilirubin ≤ 1.5 institutional ULN unless patient has Gilbert’s syndrome in which case total serum bilirubin must be <2 ULN for the institution AST and/or ALT ≤ 2.5 x ULN for the institution. (or ≤ 5 x ULN if liver metastases are present); - Serum creatinine ≤ 1.5 x ULN for the institution (or calculated creatinine clearance ≥ 45 mL/min/1.73 m2);
• Adequate bone marrow function, defined as: - Total leukocytes >/= 2.5 x 109/L; - ANC >/= 1.5 x 109/L; - Platelet count >/= 100 x 109/L;
• Able to understand and give written informed consent
• Females of childbearing potential must have a negative serum pregnancy test within 7 days prior to study enrollment;