BIBF 1120 in Bevacizumab Resistant, Persistent, or Recurrent Epithelial Ovarian Cancer

Inclusion Criteria:

* Recurrent or persistent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma w/ histologic documentation of the original primary tumor via the pathology report:

  * serious, endometrioid, mucinous, or clear cell adenocarcinoma
  * undifferentiated, mixed epithelial or transitional cell carcinoma
  * Brenner's Tumor
  * adenocarcinoma NOS
* Had treatment-free interval following response to bevacizumab (CR, PR, or SD) of \< 6 months, or have progressed during treatment w/ a bevacizumab-containing therapy
* Measurable or detectable disease. Measurable is defined by RECIST 1.1. Each lesion must be ≥ 10 mm when measured by CT, MRI or caliper measurement by clinical exam; or ≥ 20 mm when measured by chest x-ray. Lymph nodes must be \> 15 mm in short axis when measured by CT or MRI. Detectable defined as no measurable disease but either ascities/pleural effusion or solid/cystic abnormalities that don't meet RECIST 1.1 - both within the setting of CA125 \>2xULN
* Those with measurable disease must have at least one "target lesion" to assess response as defined by RECIST 1.1. Tumors in a previously irradiated field will be designated as "non-target" lesions
* Must have a ECOG Performance Status of 0 or 1
* Free of active infection requiring antibiotics. Exception: uncomplicated UTI
* Recovery from effects of recent surgery, radiotherapy, or chemotherapy

  * Hormonal therapy directed at the malignant tumor must be d/c at least a week prior to registration. Hormone replacement therapy is permitted
  * Other prior therapy directed at malignant tumor, including immunologic agents, must be d/c at least 3 weeks prior to registration; 4 weeks if prior therapy was w/ bevacizumab
* Prior therapy

  * must have had one prior platinum-based chemotherapeutic regimen for management of primary disease containing carboplatin, cisplatin, or another organoplatinum compound. This initial treatment may have included intraperitoneal therapy, high-dose therapy, consolidation, non-cytotoxic agents or extended therapy administered after surgical or non-surgical assessment.
  * Allowed, to receive, but not required to receive, 2 additional cytotoxic regimens for management of recurrent or persistent disease according to the following:

    * Patients who have received only one prior cytotoxic regimen (platinum-based regimen for management of primary disease), must have a platinum-free interval of less than 12 months, or have progressed during platinum-based therapy, or have persistent disease after a platinum-based therapy.
    * Patients must NOT have received any non-cytotoxic therapy for management of recurrent or persistent disease other than bevacizumab. Patients are allowed to receive, but are not required to receive, biologic (non-cytotoxic) therapy as part of their primary treatment regimen.
* Must have adequate:

  * Bone marrow function: Absolute neutrophil count (ANC) ≥ 1,500/mcl, equivalent to (CTCAE v4.0) grade 1. Platelets ≥ 100,000/mcl. Hemoglobin (Hb) ≥ 9.0 g/dL
  * Renal function: creatinine ≤ 1.5 x upper limit of normal (ULN)
  * Hepatic function: Bilirubin should be w/in normal limits (CTCAE v4.0, grade 1). ALT/AST, should be ≤ 1.5 x ULN (CTCAE v4.0, grade 1). For patients w/ liver metastases, ALT/AST should be ≤ 2.5 x ULN; Alkaline phosphatase should be ≤ 2.5 x ULN (CTCAE v4.0, grade 1)
  * Neurologic function: Neuropathy ≤ CTCAE v4.0, grade 1
* Blood coagulation parameters: PT w/ international normalized ratio (INR) \< 1.5 x ULN \& a PTT \< 1.5 x ULN (or an in-range PTT if on a stable dose of therapeutic heparin). Low molecular weight heparin (enoxaparin or alternative anticoagulants (other than warfarin)) are acceptable.
* Signed informed consent \& authorization permitting release of personal health information
* Negative serum pregnancy test if of childbearing potential prior to study entry \& use of effective form of contraception until 3 months after receiving last drug treatment
* Patients may have undergone a major or minor surgical procedure as long as:

  * \> 28 days prior to the first date of study therapy
  * Core biopsy or IV Port placement greater than 7 days prior to the first date of study therapy

Exclusion Criteria:

* Previous treatment w/ BIBF 1120.
* Pregnant or breastfeeding.
* Received radiation to more than 25% of marrow-bearing areas
* History of other invasive malignancies, w/ the exception of non-melanoma skin cancer, if there is any evidence of other malignancy being present w/in the last five years.
* Received prior radiotherapy to any portion of the abdominal cavity or pelvis OTHER THAN for treatment of ovarian, fallopian tube, or primary peritoneal cancer w/in the last 5 years.
* Prior chemotherapy for any abdominal or pelvic tumor OTHER THAN for the treatment of ovarian, fallopian tube, or primary peritoneal cancer or localized breast cancer w/in the last 5 years.
* A history of abdominal or tracheal-esophageal fistula, or gastrointestinal perforation
* A history of intra-abdominal abcess w/in 6 months of enrollment
* Serious, uncontrolled, concomitant disorder(s) such as diabetes mellitus
* Patients w/ clinically significant cardiovascular disease including: uncontrolled hypertension: systolic \> 150 mm Hg/diastolic \> 90 mm Hg; unstable angina or who have had a myocardial infarction w/in the past six months prior to registration; congestive heart failure; cardiac arrhythmia requiring medication (doesn't include asymptomatic atrial fibrillation); grade 2 or greater peripheral vascular disease (at least brief (\<24 hours) episodes of ischemia managed non-surgically \& w/o permanent deficit.
* Serious non-healing wound, ulcer, or bone factor.

  o Granulating incisions healing by secondary intention w/ no evidence of fascial dehiscence or infection ARE eligible but require weekly wound examinations.
* Active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels.
* History/evidence upon physical examination of CNS disease, including primary brain tumor, seizures not controlled w/ standard medical therapy, any brain metastases, CVA, TIA, or subarachnoid hemorrhage w/in 6 months of the first date of treatment on this study.
* Central pulmonary metastases/recent hemoptysis (≥1/2 tsp of red blood) w/in 28 days of registration.

  * Clinically significant proteinuria (i.e. \>Grade 1) or UPC ratio above 1.0
  * Suspicion of transmural tumor bowel involvement based on the investigator's discretion.
* Clinical symptoms/signs of gastrointestinal obstruction \& require IV hydration \&/or nutrition.
* Patients taking warfarin are not eligible