Acetyl-L-Carnitine Hydrochloride in Preventing Peripheral Neuropathy in Patients With Recurrent Ovarian Epithelial Cancer, Primary Peritoneal Cavity Cancer, or Fallopian Tube Cancer Undergoing Chemotherapy

Inclusion Criteria:

* Patients must have histologic diagnosis of epithelial ovarian carcinoma, peritoneal primary or fallopian tube carcinoma, which is now recurrent
* Patients with the following histologic epithelial cell types are eligible: serous adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, transitional cell carcinoma, malignant Brenner tumor, or adenocarcinoma not otherwise specified (N.O.S.)
* All patients must have had a treatment-free interval without clinical evidence of progressive disease of at least 6 months from completion of front-line chemotherapy (both platinum and taxane); front-line therapy may have included a biologic agent (i.e., bevacizumab)

  * Front-line treatment may include maintenance therapy following complete clinical or pathological response; however, maintenance cytotoxic chemotherapy must be discontinued for a minimum of 6 months prior to documentation of recurrent disease; patients receiving maintenance biological therapy or hormonal therapy are ELIGIBLE provided their recurrence is documented more than 6 months from primary cytotoxic chemotherapy completion (includes maintenance chemotherapy) AND a minimum 4 weeks has elapsed since their last infusion of biological therapy
  * Patients receiving hormonal therapy for biochemical or non-measurable recurrence disease are ELIGIBLE provided their recurrence is documented more than 6 months following the completion of primary cytotoxic chemotherapy; a minimum of 4 weeks must have expired since their last exposure to hormonal therapy

    * The complete response to front-line chemotherapy must have included a negative physical exam, normalization of CA125 if elevated at baseline, and negative radiographic assessment of disease, if obtained
    * Patients who have undergone reassessment laparotomy or laparoscopy following primary therapy are eligible for this study as long as they demonstrated a pathologic complete response based on the surgical assessment (i.e. all obtained specimens were histologically negative for disease)
* Patients with a past history of primary endometrial cancer within the last five years are excluded unless all of the following conditions are met:

  * Stage not greater than IB
  * No more than superficial myometrial invasion, without vascular or lymphatic invasion
  * No poorly differentiated subtypes, including papillary serous, clear cell, or other International Federation of Gynecology and Obstetrics (FIGO) grade 3 lesions
* Patients must be expected to receive a minimum of 2 cycles of paclitaxel and a platinating agent for their recurrent disease;

  * Addition of other drugs such as bevacizumab is acceptable as long as these additional drugs are not typically associated with peripheral neuropathy
  * The initial, planned infusion duration of each dose of paclitaxel must be 3 hours or less
* Patients must start the study with a GOG performance status of 2 or less
* Serum creatinine ≤ 2.5 mg/dL
* Neuropathy (sensory and motor) less than or equal to the National Cancer Institute (NCI) CTCAE v4.0 grade 1
* No patients with a history of seizure activity
* No patients who are unable to swallow oral medications
* Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are excluded if there is any evidence of other malignancy being present within the last five years
* No patients of childbearing potential not practicing adequate contraception
* No patients who are pregnant or nursing
* No patients who are known to have diabetes
* No patients with known allergies to ALC (acetyl-L-carnitine hydrochloride)
* Patients are excluded if their previous cancer treatment contraindicates this protocol therapy
* No patients who have received more than one previous regimen of chemotherapy (maintenance is not considered a second regimen)
* No patients receiving concurrent immunotherapy or radiotherapy
* No patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis
* No patients who are currently receiving or have received warfarin or acenocoumarol within the past 7 days
* No patients taking \> 100 units of racemic vitamin E (or \> 50 units of ααα-tocopherol) daily within 5 days of starting study therapy
* No patients taking other medications (Rx, OTC, or dietary supplements) to prevent or treat neuropathy within 5 days of starting study treatment; such products include:

  * Gabapentin (Neurontin ®)
  * Pregabalin (Lyrica ®)
  * Duloxetine (Cymbalta ®)
  * Alpha-lipoic acid
  * Note that tricyclic antidepressants or selective serotonin/norepinephrine-selective reuptake inhibitors prescribed for the treatment of mood disorders are allowed