• · To determine the efficacy of the triple doublet regimen as defined by second look laparotomy
  

• · To evaluate incidence of tubulin mutations in primary and secondary surgical specimens.
  
• · To evaluate changes in IL-6, IL-8, VEGF, and FGF at primary diagnosis, during and at the conclusion of therapy.
  
• · To describe initial IL-6 levels in patients who ultimately achieve pathologic remission vs those with gross residual disease at the time of SLO.
  

Objective: To evaluate a novel regimen in ovarian carcinoma with an aim of demonstrating a higher than 50% laparotomy defined response rate. This rate is defined as the proportion of patients achieving either a pathologic complete response or a microscopic positive second look at the conclusion of therapy.

Primary study goals:

· To determine the efficacy of a triple doublet regimen in carefully defined cohorts of patients as defined by the surgical defined response rate

Secondary study goals:

• To evaluate incidence of tubulin mutations in primary and secondary surgical specimens.
• To evaluate changes in IL-6, IL-8, VEGF, and FGF, at primary diagnosis, during and at the conclusion of therapy.
• To describe initial IL-6, IL-8, and FGF levels in patients who ultimately achieve pathologic remission vs those with gross residual disease.

Patients will recieve 3 cycles of carboplatin and gemcitabine followed by 3 cycles of taxol and carboplatin and then three cycles of adriamycin and topotecan. All patients with a clinically complete response will then undergo second look operation to determine pathologically defined response.

• SLO = Second Look Operation

Inclusion Criteria:

• Histologically confirmed epithelial carcinoma of müllerian origin. Specifically, ovarian, primary peritoneal and tubal carcinoma will be allowed. All histologic subtypes are eligible.

  • Patients must have undergone an attempt at aggressive surgical debulking or alternatively be eligible for interim debulking after cycle #3. Patients debulked to no evidence of disease, microscopic disease or gross residual disease are eligible.
  • Stage II, III or IV disease. Patients with disease outside the abdominal cavity are eligible unless presentation includes brain metastases.
  • Able and willing to undergo a second look staging laparotomy.
  • Patients must give written informed consent.
  • Patient must be ag· Performance status (ECOG) >2.
  • Previous chemotherapy.
  • Creatinine > 1.5
  • History of recent MI or congestive heart failure within 6 months of surgery
  • SGOT > 2x ULN, bilirubin > 1.5 X ULN
  • Concurrent invasive malignancy. (Patients with concurrent superficial endometrial carcinoma are eligible if their endometrial carcinoma is superficial or invades less than 50% the thickness of the myometrium).
  • Known hypersensitivity to E.coli derived products?
  • Active psychiatric or mental illness that makes informed consent or careful clinical follow-up unlikely e 18 years or older.
  • Adequate bone marrow function with an ANC > 2,500 and Platelets >100,000/mm3.

Exclusion Criteria