Background: Patients with advanced ovarian cancer not amenable to primary debulking surgery are candidates for neoadjuvant chemotherapy (NACT). Patients achieving a complete pathologic response (cPR) with NACT have superior overall survival; however, the rate of cPR is only 7.5%. In ovarian cancer, tumor infiltrating lymphocytes (TIL) are critically important in prognosis. Paclitaxel and carboplatin augment Type I immunity and decrease MDSCs and Tregs. A Phase I study of an IGFBP-2 vaccine designed to augment Type 1 immunity in Stage III/IV ovarian cancer patients was safe and induced IGFBP-2 specific immunity. Vaccination during the myeloid nadir after platinum/taxane chemotherapy has shown robust Th1 immune responses. We hypothesize that vaccination against IGFBP-2 during the myeloid nadir can synergize with NACT to improve the rate of cPR through Th1 immunity, antigen specific T cells, and TIL. Methods:Trial Design: Phase II single arm study of concurrent IGFBP-2 vaccination with carboplatin and paclitaxel. Patients receive NACT IV on day 1 of each 3 week cycle and receive the IGFBP-2 vaccination on day 14. Study treatment includes 3 vaccinations, evaluations at 1 week and 6 months post vaccine and yearly follow-up for 5 years. Toxicity is assessed at baseline and through end of study. Blood and tumor tissue will be collected for immunologic monitoring and evaluation. Eligibility: Patients with newly diagnosed advanced stage ovarian cancer who will receive NACT with subsequent planned cytoreductive surgery. Specific aims: (1) Determine the rate of pCR, (2) Determine the level of TIL in residual tumor (2) Determine whether IGFBP-2 induces IGFBP-2 specific T cells, (3) Explore if there is a predictive signature for pCR when IGFBP-2 vaccination is used with NACT. Statistical Methods: (1) The sample size of 38 will provide 80% power to detect a significant increase in pCR to 20% when compared to NACT alone, (2) Tumor tissue will be evaluated for TIL, (3) IGFBP-2 specific INF-g/IL-10 ratios by ELISPOT will be evaluated, (4) Whole exome sequencing will be performed to correlate expression profiles with response to vaccination. Targeted Accrual: 7 of the planned 38 patients have been enrolled. Clinical trial information: NCT03029611