Tivozanib As Maintenance Therapy In GYN

Inclusion Criteria:

No evidence of disease on CT/MRI following treatment for recurrent ovarian, fallopian tube, or peritoneal cancer.
High-grade papillary serous carcinoma of the ovary, fallopian tube or peritoneum. Histological confirmation of the original primary tumor is required.
CA-125 within normal range.
Age greater than or equal to 18 years.
1 prior line of therapy (cytotoxic therapy only) in the recurrent setting is allowed. Bevacizumab in the upfront setting allowed, however Bevacizumab or other VEGF pathway targeted therapy in the recurrent setting is not allowed. Hormonal therapy does not count as a prior line.
Recovered from effects of recent surgery, radiotherapy, and chemotherapy.
ECOG performance status ≤ 2

Organ and marrow function as defined below:

Absolute neutrophil count ≥1,250/mcL
Platelets ≥100,000/mcL
Bilirubin ≤ 1.5 x ULN
AST (SGOT) / ALT (SGPT) ≤ 2.5 x institutional upper limit of normal Alkaline phosphatase ≤ to 2.5 x ULN
Creatinine ≤ 1.5 x institutional upper limit
Less than or equal to 1+ proteinuria on two consecutive dipsticks taken no less than 1 week apart, or < 1 gm protein on 24-hour urine collection or a urine protein:creatinine ratio of < 1.
INR < 1.5; if on anticoagulation: INR is required to be between 2 and 3.

Patient must receive one of these three regimens for their platinum sensitive disease (number of cycles should not have exceeded 8 cycles of 1 regimen in the recurrent setting):

Platinum (Carboplatin or Cisplatin) and Taxane (Paclitaxel or Docetaxel) Carboplatin and Gemcitabine
Carboplatin and Liposomal Doxorubicin
Females not of childbearing potential or has documentation of a negative pregnancy test prior to the start of the study treatment are eligible. Sexually active pre-menopausal female subjects must agree to use adequate, highly effective contraceptive measures, while on study and for 45 days after the last dose of last study drug. Effective birth control includes (a) intrauterine device (IUD) plus one barrier method; (b) oral, implantable or injectable contraceptives plus one barrier method; or (c) 2 barrier methods. Effective barrier methods are male or female condoms, diaphragms, and spermicides (creams or gels that contain a chemical to kill sperm).
Able and willing to sign a written informed consent document.

Exclusion Criteria:

Prior therapy with bevacizumab or other VEGF pathway targeted therapy in the recurrent setting. Bevacizumab in the upfront setting is allowed.
Receiving any other study agents.
Subjects with treated limited stage basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the breast or cervix are eligible. Subjects with prior cancer treated with a curative intent with no evidence of recurrent disease 5 years following diagnosis and judged by the investigator to be at low risk of recurrence are eligible. Subjects with any other concomitant or prior malignancies are ineligible.
Serious non-healing wounds or ulcers at the time of registration.
History of abdominal fistula or gastrointestinal perforation.
Active bleeding.
Clinically significant cardiovascular disease.
History of allergic reactions attributed to compounds of similar chemical or biologic composition to Tivozanib.
Symptomatic left ventricular dysfunction or baseline left ventricular ejection fraction (LVEF) by multigated acquisition scan (MUGA) or echocardiogram (ECHO) ≤ 50 % lower limit of institutional normal (LLN).
Uncontrolled hypertension: systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg documented on 2 consecutive measurements taken at least 24 hours apart.
Myocardial infarction, severe angina, or unstable angina within 6 months prior to administration of first dose of study drug.
History of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation).
Cardiac arrhythmias requiring anti-arrhythmic medications (except for atrial fibrillation that is well controlled with anti-arrhythmic medication).
Coronary or peripheral artery bypass graft within 6 months of screening.
History of Class III or IV congestive heart failure, as defined by the New York Heart Association.
Central nervous system metastases.

Note: Subjects with previously treated (radiotherapy or surgery) brain metastasis that have been stable without steroid treatment for at least 3 months following prior treatment may be enrolled.