Trial of Radical Upfront Surgical Therapy (TRUST) in Advanced Ovarian Cancer
- Abdominal Cancers Alliance
- Jul 1
- 2 min read
Updated: Jul 10
Sven Mahner, Florian Heitz, Sahar Salehi, Alexander Reuss, Frederic Guyon, Andreas du Bois, Philipp Harter, Christina Fotopoulou, Denis Querleu, Berit Jul Mosgard, Bernhard Krämer, Francesco Raspagliesi, Björn Lampe, Alexander Burges, Barbara Schmalfeldt, Pauline Wimberger, Holger Bronger, Dennis Chi, Jalid Sehouli, Giovanni Aletti and the TRUST investigators
2025 ASCO Annual Meeting, Abstract #LBA5500
A new late-breaking phase III trial, TRUST, examined the impact of primary cytoreductive surgery—commonly known as upfront surgery—compared to neoadjuvant chemotherapy followed by interval surgery in patients with suspected resectable stage III–IV ovarian cancer.
Background
The TRUST (Trial of Radical Upfront Surgical Therapy) study is an ambitious, international, randomized phase III trial designed to determine the optimal timing of surgery in advanced ovarian, tubal, and primary peritoneal cancer (FIGO stage IIIB–IVB). Historically, primary debulking surgery (PDS) followed by chemotherapy has been the standard approach. However, earlier trials such as EORTC‑GCG and CHORUS demonstrated that neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) could achieve similar survival outcomes—albeit with concerns around variable surgical completeness and patient selection.
TRUST aims to clarify these uncertainties by comparing overall survival between upfront primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in a high-quality surgical setting. Key design features include rigorous participation criteria—each center must maintain a ≥50% complete resection rate and perform at least 36 debulking surgeries per year, with independent audits to ensure consistency and quality. The trial enrolled around 772 patients, randomizing them to either immediate surgery followed by six cycles of platinum-based chemotherapy or three cycles of chemotherapy before and after surgery.
By controlling for surgical expertise and focusing on complete tumor removal, TRUST addresses critical gaps left by earlier studies. Its goal is to provide clear evidence on whether upfront surgery improves overall survival compared to a chemotherapy-first approach, helping guide treatment planning for women with advanced ovarian-related cancers.
Key Findings
Improved progression‑free survival (PFS) with immediate surgery compared to delayed surgery after chemotherapy, though the absolute gain was modest .
No significant overall survival advantage was observed between the two approaches .
Safety profiles were comparable, and there was no increased surgical morbidity associated with upfront surgery
Conclusion
For selected patients with high likelihood of complete resection, primary debulking surgery remains a strong option to delay disease progression. However, because overall survival was similar, the choice should be carefully personalized—balancing tumor resectability, patient fitness, and preference for timing of chemotherapy. This nuanced evidence empowers multidisciplinary teams and patients to make informed decisions about treatment sequencing.
