This research is looking at the effect of biobehavioral factors such as stress and whether
these factors alter how the body responds to chemotherapy, one of the purposes of this study
is to determine if the addition of a beta-blocker such as Propranolol (Inderal) is tolerable
when given with chemotherapy in the treatment of newly diagnosed ovarian, fallopian tube, or
primary peritoneal cancer. An additional purpose of the study is to understand if
behavioral factors such as depression and anxiety can alter different blood markers that
affect tumor vascularity. The Investigator wishes to determine whether the use of
beta-blocker drugs such as Inderal, might alter these behavioral factors by drawing blood
prior to and after the administration of Inderal as well as giving behavioral questionaires
at different time points. Beta-blockers are commonly used for the treatment of
hypertension, protection of the heart after a heart attack, and irregularities in
heartbeats. Altering these factors might boost the immune system and affect other areas of
cancer biology, thereby allowing the chemotherapy to be more effective. The significance of
this research is that it may help improve our treatments of this disease in the future.
Minimum age: 18 Years.
Maximum age: N/A.
Inclusion Criteria: 1. Histologic diagnosis of invasive epithelial ovarian cancer, primary
peritoneal carcinoma, fallopian tube cancer. Histologic epithelial cell types are
eligible: serous adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma,
undifferentiated carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or
adenocarcinoma not otherwise specified. However, the histologic features must be
compatible with primary Müllerian epithelial adenocarcinoma. Patients with low grade
invasive epithelial ovarian cancers may participate.
2. Stages II-IV of the above cancer
3. Patients having undergone a suboptimal or optimal tumor debulking
4. Gynecologic Oncology Group performance status 0-2
5. Patients must have adequate:
1. Bone marrow function: Absolute neutrophil count (ANC) greater than or equal to
2. Platelets greater than 100,000/ml
3. Renal function: Creatinine <1. 5 x institutional upper limit normal
4. Hepatic function: Bilirubin less than or equal to 1. 5 x institutional upper limit
normal; SGOT and alkaline phosphatase less than or equal to 2. 5 x institutional upper
5. Neurologic function: Neuropathy (sensory and motor) less than or equal to grade 1
according to Common Toxicity Criteria for Adverse Events version 3 (CTCAE).
6. Blood coagulation parameters: PT such that international normalized ratio (INR) is
<1. 5 (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose
of therapeutic warfarin for the management of venous thrombosis including pulmonary
embolus) and a PTT <1. 2 times institutional upper limit of normal.
6. Surgery must be scheduled at least 72 hours in advance in order for the patient to
take at least 48 hours of prescribed Propranolol.
7. An approved informed consent and authorization permitting release of personal
health information must be signed by patient or guardian.
8. Age > 18 years
9. Patients of childbearing age must have a negative pregnancy test.
Exclusion Criteria: a. Patients who receive neoadjuvant chemotherapy for their ovarian,
primary peritoneal, or fallopian tube cancer are excluded.
b. Patients with non-epithelial ovarian tumors, borderline epithelial ovarian tumor, or
recurrent invasive epithelial ovarian, low grade ovarian cancer, primary peritoneal, or
fallopian tube cancer treated with surgery only (such as patients with stage IA or IB).
Patients with a prior diagnosis of a borderline tumor that was surgically resected and who
subsequently develop an unrelated new invasive epithelial ovarian, primary peritoneal, or
fallopian tube cancer are eligible, provided that they have not received chemotherapy for
c. Patients who have received prior radiotherapy to any portion of the abdominal cavity or
pelvis are excluded. Prior radiation therapy for localized cancer of the breast, head and
neck, or skin is permitted provided that it was completed more than 3 years prior to
registration, and the patient remains free of recurrent or metastatic disease.
d. Patients with a synchronous primary endometrial cancer, or a past history of primary
endometrial cancer are excluded unless all of the following conditions are met: stage not
greater than stage IA; no more than superficial myometrial invasion, without vascular or
lymphatic invasion; no poorly differentiated subtypes, including papillary serous, clear
cell, or other FIGO grade 3 lesions.
e. Patients who have received targeted therapy (including but not limited to vaccines,
antibodies, tyrosine kinase inhibitors) or hormonal therapy for management of their
primary peritoneal, ovarian, or fallopian tube cancer. Patients cannot receive concurrent
bevacizumab or other targeted therapy as part of their primary chemotherapy.
f. With the exception of non-melanoma skin cancer and other specific malignancies as noted
above, patients with other invasive malignancies who had (or have) any evidence of the
other cancer present with the last five years or whose previous cancer treatment
contraindicates this protocol therapy are excluded.
g. Metastases to the ovaries from other organs except fallopian tube or primary peritoneal
h. Use of systemic glucocorticoids such as Prednisone or Decadron in the last month
i. Inability to accurately answer questions (e. g. dementia, brain metastases) or speak
j. Cirrhosis of the liver
k. Patients with a GOG Performance status 3 or 4
l. Patients under the age of 18
m. Comorbid conditions: Addison's disease, autoimmune hepatitis, hepatitis B, hepatitis C,
AIDS or HIV, lupus erythematosus, mixed connective tissue disease, rheumatoid arthritis.
n. Any patients already on beta-blockers or contraindicated to receive beta-blockers.
Refer to section 5. 48