The study is closed per results from the interim analysis.

This phase II trial studies how well auranofin and sirolimus work in treating participants with ovarian cancer. Immunosuppressive therapy, such as auranofin and sirolimus, is used to decrease the body?s immune response and may increase blood cell count.

PRIMARY OBJECTIVES:

I. To estimate the overall tumor response rate (ORR, that is, complete response [CR] + partial response [PR]) of the combination of auranofin and sirolimus in the setting of metastatic serous ovarian cancer across all patients.

SECONDARY OBJECTIVES:

I. To estimate the overall tumor response rate (ORR, that is, complete response [CR] + partial response [PR]) of the combination of auranofin and sirolimus in the setting of metastatic serous ovarian cancer within patients that have overexpression of PKCiota.

II. To estimate progression-free survival, overall survival, and adverse events from the combination of auranofin and sirolimus.

CORRELATIVE OBJECTIVES:

I. To explore whether PKCiota-relevant biomarkers in serous ovarian cancer tumors are associated with treatment response patterns, such as ORR, progression free survival, and overall survival.

OUTLINE:

Participants receive auranofin orally (PO) once daily (QD) and sirolimus PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unaccepted toxicity.

After completion of study treatment, participants are followed up every 6 months for 3 years.

Inclusion Criteria:

• Eastern Cooperative Oncology Group (ECOG) performance score of 0 or 1
• Ovarian, Fallopian Tube or Primary Peritoneal cancer of serous histology
• Incurable cancer
• Willingness to provide paraffin-embedded tissue blocks of ovarian cancer
• Measurable disease
• Obtained =< 14 days prior to registration: Absolute neutrophil count (ANC) >= 1500 uL
• Obtained =< 14 days prior to registration: Platelet (PLT) >= 100,000 uL
• Obtained =< 14 days prior to registration: Hemoglobin (Hgb) >= 9 g/dL
• Obtained =< 14 days prior to registration: Total bilirubin =< 1.5 x upper limit of normal (ULN) or direct bilirubin =< ULN
• Obtained =< 14 days prior to registration: Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 3 x ULN or SGOT (AST) and SGPT (ALT) =< 5 x ULN is acceptable if liver has tumor involvement
• Obtained =< 14 days prior to registration: Creatinine =< 1.5 x ULN
• Obtained =< 14 days prior to registration: Fasting serum glucose =< 1.5 x ULN
• Obtained =< 14 days prior to registration: Total cholesterol =< 1.5 x ULN
• Obtained =< 14 days prior to registration: Triglycerides =< 1.5 x ULN
• Life expectancy >= 12 weeks

Exclusion Criteria:

• Platinum-sensitive disease (exceptions allowed: patient has had a hypersensitivity reaction to platinum or the treating oncologist thinks that further platinum therapy is not in the patient?s best interest)

• Morbidities or concurrent major illness (for example, bowel obstruction or a second active malignancy) that, in the opinion of the treating healthcare provider, would make participation in the trial problematic

• Leptomeningeal disease or uncontrolled brain metastasis

• Failure to recover from acute, reversible effects of prior therapy regardless of interval since last treatment

  • NOTE: Patients can have peripheral (sensory) neuropathy

• History of hypertriglyceridemia or hypercholesterolemia and currently on medication(s)

• Use of St. John?s wort =< 7 days prior to registration

• Unable to discontinue use of a strong CYP3A4 inhibitor

Up to 2 years

Participants evaluable for adverse events are summarized below (i.e. participants who did not withdraw consent).