Letrozole with or without Paclitaxel and Carboplatin in Treating Patients with Stage II-IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
This phase III trial studies how well letrozole with or without paclitaxel and carboplatin works in treating patients with stage II-IV low-grade serous carcinoma of the ovary, fallopian tube, or peritoneum. Letrozole is an enzyme inhibitor that lowers the amount of estrogen made by the body which in turn may stop the growth of tumor cells that need estrogen to grow. Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving letrozole alone or in combination with paclitaxel and carboplatin works better in treating patients with low-grade serous carcinoma of the ovary, fallopian tube, or peritoneum compared to paclitaxel and carboplatin without letrozole.
Eligibility
Inclusion Criterea
			
				- Patients must have newly diagnosed, stage II-IV low-grade serous ovarian cancer (submission of pathology report[s] required). Ovarian cancer = ovarian, fallopian tube and primary peritoneal cancers
* NOTE: Patients with a prior history of serous borderline tumors but a new diagnosis of stage II-IV low-grade serous ovarian cancer are eligible
* p53 immunohistochemistry (IHC) is required and must show nonaberrant pattern (nonaberrant p53 expression is consistent with normal/wildtype TP53)
** A copy of the pathology report that includes the diagnosis of low grade serous ovarian cancer and nonaberrant p53 IHC result must be submitted in RAVE. NOTE: If aberrant p53 expression is found on p53 IHC, the patient is NOT eligible (aberrant p53 expression is consistent with mutant TP53 and supports diagnosis of high grade serous ovarian cancer)
 
		 
		
			
				- Appropriate stage for study entry based on the following diagnostic workup:
* History/physical examination within 14 days prior to registration;
* Radiographic tumor assessment within 28 days prior to registration. (23-MAY-2023)
 
		 
		
			
				- Age >= 18
 
		 
		
			
				- Patients must have undergone an attempt at maximal upfront cytoreductive surgery, with either optimal (= 1 cm diameter residual disease/nodule) status allowed
 
		 
		
			
				- Patients must have undergone a bilateral salpingo-oophorectomy
 
		 
		
			
				- Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2 within 14 days prior to registration
 
		 
		
			
				- Patients must be within =< 8 weeks of primary cytoreductive surgery at time of randomization
 
		 
		
			
				- Patients must be able to take per oral (P.O.) medications
 
		 
		
			
				- Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl (within 14 days prior to registration)
 
		 
		
			
				- Platelets greater than or equal to 100,000 cells/mcl (within 14 days prior to registration)
 
		 
		
			
				- Creatinine less than or equal to 1.5 x upper limit of normal (ULN) (within 14 days prior to registration)
 
		 
		
			
				- Bilirubin less than or equal to 1.5 x ULN (within 14 days prior to registration)
 
		 
		
			
				- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than or equal to 3 x ULN (within 14 days prior to registration)
 
		 
		
			
				- The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information
 
		 
		
			
				- Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
 
		 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
	
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
			 
		
			
				
		- Patients may not have received neoadjuvant or adjuvant chemotherapy or radiotherapy for the treatment of this disease
 
		
		 
		
			
				
		- Patients may not have received previous hormonal therapy for the treatment of this disease
 
		
		 
		
			
				
		- Patients with known hypersensitivity to letrozole or hypersensitivity/intolerance to carboplatin/paclitaxel therapy
 
		
		 
		
			
				
		- Patients with severe cardiac disease:
* Myocardial infarction or unstable angina within 6 months prior to registration
* New York Heart Association (NYHA) class II or greater congestive heart failure
 
		
		 
		
			
				
		- Patients with known central nervous system metastases
 
		
		 
		
			
				
		- Patients with active (except for uncomplicated urinary tract infection) or uncontrolled systemic infection
 
		
		 
		
			
				
		- Patients with >= grade 2 baseline neuropathy
 
		
		 
		
			
				
		- Known human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
 
		
		 
		
	
Participating Clinics
	
		
		North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
		
	 
		
		Hope Cancer Care of Nevada
		
	 
		
		Comprehensive Cancer Centers of Nevada-Horizon Ridge
		
	 
		
		OptumCare Cancer Care at Seven Hills
		
	 
		
		Kingman Regional Medical Center
		
	 
		
		Radiation Oncology Associates
		
	 
		
		Cancer and Blood Specialists-Henderson
		
	 
		
		Radiation Oncology Centers of Nevada Central
		
	 
		
		GenesisCare USA - Vegas Tenaya
		
	 
		
		Comprehensive Cancer Centers of Nevada - Town Center
		
	 
		
		
		OptumCare Cancer Care at Fort Apache
		
	 
		
		Comprehensive Cancer Centers of Nevada - Henderson
		
	 
		
		Comprehensive Cancer Centers of Nevada-Southeast Henderson
		
	 
		
		University Medical Center of Southern Nevada
		
	 
		
		Comprehensive Cancer Centers of Nevada - Central Valley
		
	 
		
		Hope Cancer Care of Nevada-Pahrump
		
	 
		
		GenesisCare USA - Fort Apache
		
	 
		
		GenesisCare USA - Las Vegas
		
	 
		
		Comprehensive Cancer Centers of Nevada-Summerlin
		
	 
		
		OptumCare Cancer Care at MountainView
		
	 
		
		Comprehensive Cancer Centers of Nevada
		
	 
		
		Summerlin Hospital Medical Center
		
	 
		
		Radiation Oncology Centers of Nevada Southeast
		
	 
		
		Saint Mary's Regional Medical Center
		
	 
		
		Renown Regional Medical Center
		
	 
		
		
		Alliance for Childhood Diseases/Cure 4 the Kids Foundation
		
	 
		
		Comprehensive Cancer Centers of Nevada - Northwest
		
	 
		
		GenesisCare USA - Henderson
		
	 
		
		OptumCare Cancer Care at Charleston
		
	 
		
		Carson Tahoe Regional Medical Center
		
	 
		
		
		Sunrise Hospital and Medical Center
		
	 
		
		Las Vegas Urology - Green Valley
		
	 
		
		Las Vegas Urology - Sunset
		
	 
		
		Urology Specialists of Nevada - Northwest
		
	 
		
		Las Vegas Urology - Pebble
		
	 
		
		Urology Specialists of Nevada - Southwest
		
	 
		
		Urology Specialists of Nevada - Green Valley
		
	 
		
		Urology Specialists of Nevada - Central
		
	 
		
		Las Vegas Urology - Pecos
		
	 
		
		Las Vegas Urology - Cathedral Rock
		
	 
		
		Las Vegas Prostate Cancer Center