Ovarian Cancer: Surgery vs. Chemo – Timing Matters
For women battling advanced ovarian cancer, the timing of surgery versus chemotherapy profoundly impacts treatment outcomes.Groundbreaking findings from the TRUST trial presented at ASCO 2025 reveal that primary surgery followed by chemotherapy considerably improved progression-free survival by 2.4 months compared with initial chemotherapy. While overall survival showed a positive trend with upfront surgery, the difference wasn’t statistically significant. This study underscores the crucial need for careful patient selection due to the potential for higher complication rates with primary debulking surgery, a key consideration for anyone diagnosed with advanced ovarian cancer. News Directory 3 is committed to bringing you the cutting-edge information on crucial health findings. The study also reveals that complete cytoreduction after primary surgery showed the most significant benefits for patients. Discover what’s next for refining patient selection criteria to maximize treatment success.
TRUST Trial: Surgery Timing Key in Advanced Ovarian Cancer Treatment
Updated June 08, 2025
For women with advanced ovarian cancer, the optimal treatment approach remains a subject of debate. The TRUST trial, presented at the American Society of Clinical Oncology (ASCO) 2025 meeting, investigated whether initial surgery followed by chemotherapy or chemotherapy before surgery yields better outcomes in patients with resectable stage IIIB-IVB ovarian cancer. The study aimed to determine the best timing for cytoreductive surgery in thes cases, focusing on progression-free survival (PFS) and overall survival.
The TRUST trial revealed that primary cytoreductive surgery, followed by chemotherapy, resulted in a statistically significant 2.4-month improvement in median progression-free survival compared to neoadjuvant chemotherapy followed by interval cytoreductive surgery. While overall survival was six months longer in the upfront surgery group, this difference did not reach statistical significance. Quality of life was similar in both groups over a three-year period.
Dr. Sven Mahner, lead investigator from Ludwig Maximilian University Hospital, Munich, Germany, highlighted the significant PFS benefit without compromising quality of life. However, Dr. Emma Barber, a gynecologic oncologist at Northwestern Memorial Hospital, Chicago, expressed caution, citing the lack of significant overall survival benefit and higher complication rates associated with upfront surgery. The study underscores the importance of careful patient selection when considering primary debulking surgery versus neoadjuvant chemotherapy for advanced ovarian cancer treatment.
“TRUST is the first randomized controlled trial to show a significant benefit in median PFS without compromising short- or long-term quality of life,” saeid Mahner.
The trial randomly assigned 688 patients to either primary cytoreductive surgery followed by six cycles of chemotherapy or three cycles of neoadjuvant chemotherapy followed by interval cytoreductive surgery plus three more chemotherapy cycles. most patients had stage IIIc disease with high-grade serous histology. surgical effort was high in both groups, leading to complete resection rates of 70% in the primary surgery group and 85% in the interval surgery group.
The median PFS was 22.1 months after primary surgery compared to 19.7 months after interval surgery. while the primary surgery group showed a 6-month overall survival benefit, the difference was not statistically significant. Subgroup analyses indicated that patients with complete cytoreduction after primary surgery and those with stage III disease experienced the most significant benefits from upfront surgery.
What’s next
Future research should focus on refining patient selection criteria to identify those most likely to benefit from primary cytoreductive surgery, balancing the potential for improved progression-free survival against the risk of increased complications.Further analysis of the TRUST trial data may provide additional insights into the long-term outcomes and optimal treatment strategies for advanced ovarian cancer.