Evaluation of TRC105 in the Treatment of Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Carcinoma

Angiogenesis plays a central role in the progression of epithelial ovarian cancer. In mouse
models, VEGF-inhibitors diminish ovarian tumor growth, metastasis and malignant ascites
formation. Independent Phase 2 trials have demonstrated single-agent activity for bevacizumab
in recurrent ovarian cancer, and randomized controlled Phase 3 trials are ongoing in the
first-line setting (GOG 0218 and ICON-7) and for recurrent disease (GOG 0213, OCEANS).

TRC105 is an antibody to CD105, an important non-VEGF angiogenic target on vascular
endothelial cells. TRC105 inhibits angiogenesis, tumor growth and metastases in preclinical
models. In a Phase 1 study of advanced solid tumors, TRC105 therapy caused a global reduction
in angiogenic biomarkers and reduced tumor burden at doses that were well-tolerated. We
hypothesize that TRC105 will have single-agent activity in recurrent ovarian cancer. By
targeting a non-VEGF pathway, TRC105 has the potential to complement VEGF inhibitors which
could represent a major advance in ovarian cancer therapy.

Inclusion Criteria:

- Recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma

- Measurable disease per RECIST 1.1

- At least one "target lesion" per RECIST 1.1

- Patients must have GOG Performance Status of 0 or 1

- Patients must have a life expectancy of ≥ 3 months

- Resolution of all acute toxic effects of prior therapy

- Free of active infection requiring antibiotics

- Must have had one prior platinum-based chemotherapeutic regimen for management of
primary disease

- Patients could have received one additional cytotoxic regimen for management of
recurrent disease

- Prior therapy directed at the malignant tumor, including hormonal and immunologic
agents, must be discontinued at least three weeks prior to registration. Continuation
of hormone replacement therapy is permitted.

- Adequate bone marrow function, renal function, hepatic function, neurologic function,
blood coagulation parameters

- Negative serum pregnancy test and effective form of contraception for patients of
childbearing potential

Exclusion Criteria:

- Previous treatment with TRC105

- Current treatment on another therapeutic clinical trial

- Receipt of an investigational agent within 28 days of starting study treatment

- Serious, non-healing wounds, ulcers, or bone fractures.

- Active bleeding or pathologic conditions that carry a high risk of bleeding

- Patients with tumor involving major vessels or transmural bowel wall involvement by
tumor

- Use of thrombolytic or anticoagulant agents (except heparin to maintain i.v.
catheters) within 10 days prior to the first dose of TRC105

- History of deep venous thrombosis (DVT)(except patients who have received adequate
anticoagulation are eligible, and may continue on anticoagulation if appropriate)

- History of peptic ulcer disease or erosive gastritis within the past 6 months

- Known active viral or nonviral hepatitis

- History or evidence of CNS disease

- Clinically significant cardiovascular disease

- Known hypersensitivity to Chinese hamster ovary cell products or other recombinant
human, chimeric, or humanized antibodies

- Pregnant or nursing

- Under the age of 18

- Patients with or with anticipation of invasive procedures including major surgical
procedure, open biopsy or significant traumatic injury within 28 days prior to
treatment with TRC105

- History of other invasive malignancies, except non-melanoma skin cancer and other
cancers that have been treated with no evidence of disease within the last 3 years

- History of primary endometrial cancer diagnosed within the last 5 years, unless all of
the following conditions are met: Stage not greater than I-B; no more than superficial
myometrial invasion, without vascular or lymphatic invasion; no poorly differentiated
subtypes, including papillary serous, clear cell or other FIGO Grade 3 lesions

- Patients who have received prior chemotherapy for any abdominal or pelvic tumor OTHER
THAN for the treatment of ovarian, fallopian tube, or primary peritoneal cancer within
the last five years are excluded. Patients may have received prior adjuvant
chemotherapy for localized breast cancer, provided that it was completed > 3 years
prior to registration, and patient remains free of recurrent or metastatic disease

- Prior radiotherapy to any portion of the abdominal cavity or pelvis

- Patients with clinical symptoms or signs of gastrointestinal obstruction and who
require parenteral hydration and/or nutrition