Combination Chemotherapy and Autologous Peripheral Stem Cell Transplant in Treating Patients With Stage III, Stage IV, or Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer
Combination Chemotherapy and Autologous Peripheral Stem Cell Transplant in Treating Patients With Stage III, Stage IV, or Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cancer, or Fallopian Tube Cancer
RATIONALE: Giving chemotherapy before a peripheral stem cell transplant stops the growth of
 tumor cells by stopping them from dividing or killing them. Giving colony-stimulating
 factors, such as G-CSF, and certain chemotherapy drugs, helps stem cells move from the bone
 marrow to the blood so they can be collected and stored. More chemotherapy is then given to
 prepare the bone marrow for the stem cell transplant. The stem cells are then returned to the
 patient to replace the blood-forming cells that were destroyed by the chemotherapy.

 PURPOSE: This phase I trial is studying the side effects and best dose of topotecan when
 given together with cyclophosphamide, paclitaxel, melphalan, and cisplatin, followed by an
 autologous peripheral stem cell transplant in treating patients with stage III, stage IV, or
 recurrent ovarian epithelial cancer, primary peritoneal cancer, or fallopian tube cancer.
OBJECTIVES:

 -  To establish the maximum tolerated dose (MTD) of continuous infusion intravenous
 topotecan hydrochloride when administered with intraperitoneal (IP) cisplatin and
 intravenous melphalan in patients with stage III, stage IV, or recurrent ovarian
 epithelial cancer, primary peritoneal cancer, or fallopian tube cancer.

 -  To describe the toxicities of each dose studied.

 -  To evaluate the pharmacokinetics of topotecan hydrochloride when administered at the
 maximum tolerated dose and cisplatin.

 -  To confirm the pharmacokinetic advantage of high-dose IP cisplatin and IP paclitaxel.

 -  To obtain tissue at the time of peritoneal catheter placement in order to evaluate the
 molecular determinants of apoptosis (including p53 status, p21 gene expression, bcl-2
 gene expression, and bcl-2/bax ratio) and the extent of apoptosis by the TdT assay.

 -  To evaluate the molecular determinants of DNA damage and repair, including expression
 levels of ERCC1 and MDR1, and HER2/neu expression by immunohistochemistry.

 OUTLINE: This is a dose-escalation study of topotecan hydrochloride.

 Patients undergo surgical placement of an intraperitoneal (IP) catheter. Tumor biopsies are
 obtained during surgery for laboratory analysis of molecular determinants of apoptosis
 (including p53 status, p21 gene expression, bcl-2 gene expression, bcl-2/bax ratio) and
 molecular determinants of DNA damage and repair (including expression levels of ERCC1 and
 MDR1, and HER2/neu expression by immunohistochemistry). The extent of apoptosis is also
 assessed using the TdT assay.

 -  Course 1: Patients receive paclitaxel IP on day 1, cyclophosphamide IV on day 2, and
 filgrastim (G-CSF) subcutaneously (SC) beginning on day 3 and continuing until apheresis
 is completed. Patients undergo apheresis until ≥ 2.5 X 10^6 CD34-positive cells/kg are
 collected. Two weeks later, patients proceed to course 2.

 -  Course 2: Patients receive cisplatin IP and melphalan IV on days -11 and -4 and
 topotecan hydrochloride by continuous infusion over 120 hours on days -10 to -6.
 Patients receive 25% of their peripheral blood stem cells (PBSCs) on day -3 and G-CSF IV
 beginning on day -3 and continuing until blood counts recover. Patients receive their
 remaining PBSCs on day 0.

 Patients undergo daily blood sample collection during topotecan hydrochloride administration
 for pharmacokinetic studies. Patients treated at the maximum tolerated dose of topotecan
 hydrochloride undergo additional blood sample collections for pharmacokinetic studies.

 After completion of study therapy, patients are followed every 3 months.
DISEASE CHARACTERISTICS:

 -  Histologically confirmed ovarian epithelial carcinoma, primary peritoneal cavity
 carcinoma, or epithelial carcinoma of the fallopian tubes, meeting 1 of the following
 criteria:

 -  Stage III or IV disease that was treated with initial therapy comprising a
 standard platinum-containing regimen

 -  Must have < 2 cm of residual disease with no evidence of disease progression
 after initial chemotherapy AND have no disease progression immediately prior
 to stem cell collection

 -  Patients initially presenting with stage IV disease who have achieved a
 clinical response (complete response [CR] or partial response [PR]) after
 initial therapy are eligible

 -  Responding recurrent disease

 -  Patients who have had recurrence with elevated CA 125 levels (> 100 U/mL)
 and who have achieved a reduction of CA 125 level by 50% for 4 weeks
 following the most recent course of reinduction chemotherapy are eligible

 -  Patients who have achieved a CR or PR after salvage chemotherapy for
 relapsed disease are eligible

 -  Patients with measurable or evaluable disease must have achieved a PR after prior
 therapy

 -  No clinically significant pleural effusions

 PATIENT CHARACTERISTICS:

 -  Karnofsky performance status 70-100%

 -  ANC > 1,000/μL

 -  Platelet count > 100,000/μL

 -  Serum bilirubin < 1.5 mg/dL

 -  SGOT and SGPT ≤ 2.5 times normal

 -  Creatinine clearance ≥ 60 mL/min

 -  No active cardiac disease that, in the opinion of the investigator, would preclude
 safe administration of chemotherapy

 -  Cardiac ejection fraction normal at rest by MUGA

 -  No history of potentially disabling psychiatric disorders

 -  Hepatitis B antigen, hepatitis C antibody, and HIV antibody negative

 -  No clinically significant peripheral neuropathy

 -  FEV_1 ≥ 2.0 L or ≥ 75% of the lower limit of normal

 PRIOR CONCURRENT THERAPY:

 -  See Disease Characteristics

 -  At least 4 weeks since prior chemotherapy or radiotherapy

 -  No prior radiotherapy to the whole abdomen