Utility of Adjusting Chemotherapy Dose & Dosing Schedule with the SALVage Weekly Dose-dense Regimen in Patients with Poor Prognostic OVARian Cancers Based on the Tumor Unfavorable Primary Chemosensitivity and Incomplete Debulking Surgery

Inclusion Criteria:

1. Histologically confirmed high-grade epithelial (serous, endometrioid, orcarcinosarcoma with a ≥30% epithelial tumor component) ovarian, primary peritoneal,or fallopian-tube carcinoma

2. Adult patient aged ≥ 18 years old

3. Advanced stage III or IV disease

4. Treated with 3 to 4 neo-adjuvant cycles of standard 3-weekly carboplatin-paclitaxelregimen in first-line setting, and characterized by:

• Unfavorable standardized KELIMTM score < 1.0 calculated with the KELIM academictool and available for free on internet site (https://www.biomarker-kinetics.org/CA-125-neo) (poor primary chemosensitivity)

• Not amenable to complete interval debulking surgery (incomplete intervaldebulking surgery attempt, or disease not operated at all because considerednot amenable to complete surgery by surgeon) Of note, a pre-screening inclusionbefore the start of neo-adjuvant chemotherapy is encouraged as a way ofprospectively assessing the CA-125 longitudinal kinetics and surgeryevaluation, and subsequently selecting the patients for the randomizationsequence

5. ECOG performance status 0 or 1 (see appendix 2)

6. Adequate organ and bone marrow function for weekly-dense chemotherapy: red bloodcells (baseline Hemoglobin ≥8 g/dL without red blood cell transfusion within 3 weeksbefore the blood work), white blood cells (Absolute neutrophil count (ANC) ≥1500cells/mm3) and platelets (Platelet count ≥100,000/mm3),

7. Adequate renal and liver functions

• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤2.5 × upperlimit of normal (ULN), or ≤5 × ULN in context of liver metastases

• Total bilirubin ≤1.5 × ULN (patients with Gilbert's are eligible if totalbilirubin ≤3 × ULN)

• Albumin ≥3 g/dL

• Creatinine clearance ≥40 mL/min/1.73 m2 (measured or estimated, ideally withCKD-EPI formula on https://www.kidney.org/professionals/kdoqi/gfr_calculator)

8. Patients who gave its written informed consent to participate to the study

9. Patients affiliated to a social insurance regime

10. Patients willing and able to comply with the protocol for the duration of the studyincluding undergoing treatment and scheduled visits and examinations includingfollow up

Exclusion Criteria:

1. Low-grade endometrioid, clear cell, mucinous, or sarcomatous histology, or mixedtumors containing any of these histologies, or low-grade or borderline ovariantumor. No contraindication to the drugs assessed in the SALVOVAR trial (carboplatin,paclitaxel, GCSF)

2. Previous treatment with bevacizumab during initial standard neo-adjuvantchemotherapy

3. Has primary platinum-refractory disease, defined as disease that has progressedduring the neo-adjuvant chemotherapy

4. Patients with concomitant cancer, except: adequately treated non-melanoma skincancer, curatively treated in-situ cancer of the cervix, or other solid tumorscuratively treated with no evidence of disease for ≥ 5 years

5. Treatment with other investigational agents in clinical trials.

6. Clinically significant uncontrolled condition(s) which, in the opinion of theInvestigator, may confound the results of the trial or interfere with the patient'ssafety or participation, including but not limited to:

• Unstable angina.

• Myocardial infarction within 6 months of first dose.

• Uncontrolled and/or severe concomitant diseases (uncontrolled hypertension, ≥Grade 3 (per CTCAE v5.0) arrhythmia, heart failure, cirrhosis).

• Active infectious disease requiring IV therapy (bacteria, viruses) within 2weeks of first dose.

• Gastric-outlet obstruction.

• Small bowel obstruction (SBO) defined as computed tomography (CT) scan showing:Dilated loops of small bowel ≤12 weeks of study entry, symptomaticascites/effusions requiring paracentesis or thoracentesis ≤30 days of studyentry.

7. Known psychiatric disorder that would interfere with trial compliance.

8. Pregnant or lactating patients or patients expecting to conceive children within theprojected duration of the trial.

9. Patient deprived of liberty, under guardianship, or under curatorship.