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We are doing this to compare the results of early surgical intervention to medical therapy. We want to know if there is a difference in outcomes for these treatment options. We also want to track the health and progress of people with a large ascending aortic aneurysm (a bulge in the aorta caused by weakening in the artery wall).

For this type of cancer, standard treatment includes radiation therapy along with chemotherapy medicines such as carboplatin and paclitaxel. In this study, people will also receive extra chemotherapy for up to six months after the standard treatment is finished. This extra treatment is called consolidation chemotherapy. It uses common cancer medicines such as fluorouracil, leucovorin, oxaliplatin, and docetaxel. Some people may also receive a medicine called durvalumab, which helps the immune system fight cancer.

We are doing this study to find out if an experimental drug called TORL-1-23 (the study drug) is a safe and effective option for women who have advanced ovarian cancer, primary peritoneal, or fallopian tube cancer.

People in this study may get up to 8 treatment cycles. Each cycle lasts 21 days. Usually, there are 3 to 4 cycles before surgery and 2 to 4 cycles after surgery, depending on how the cancer responds and what the doctor decides. The whole treatment takes about 8 months, and doctors will check on patients for up to 15 more months. This means the study lasts about 24 months in total. Doctors will place patients into one of three groups (A, B, or C). This is not random. All groups will get a medicine called TORL 123. Group A: TORL 123 plus paclitaxel Group B: TORL 123 plus carboplatin Group C: TORL 123 plus both paclitaxel and carboplatin Medicine is given through an IV on Day 1 of each cycle. There will also be extra visits and blood tests during the cycle.

This study includes one virtual information session, some online questionnaires, five in person visits, and a twelve week exercise program that is supervised from home. All in person visits will happen at the Duke Center for Living in Durham. The exercise program includes both aerobic exercise and strength training. Each week there will be Zoom exercise classes led by a study staff member, along with workouts you complete on your own using materials the study provides.

In this study, you will have three devices used on the outside of your body to measure how your heart is working, your blood pressure, and the pressure inside your heart. During your procedure, a thin tube will also be placed into a vein in your heart called the coronary sinus. It will be gently moved into the lower part of your heart to take measurements. Your heart will then be paced, and the measurements will be taken again. These extra steps will add about twenty minutes to your procedure.