Timing of Cytoreductive Surgery Impacts Outcomes in Advanced Ovarian Cancer

By: JNCCN 360 Staff
Posted: Friday, July 18, 2025

Primary cytoreductive surgery followed by intravenous chemotherapy was found to improve progression-free survival in patients with advanced ovarian cancer compared with neoadjuvant chemotherapy followed by interval cytoreductive surgery, according to findings from the phase III TRUST trial.  

Presented at the 2025 ASCO Annual Meeting by Sven Mahner, MD, of the University Hospital Ludwig-Maximilians Munich, Germany, and colleagues, the trial looked at the optimal timing of cytoreduction in nonfrail patients with advanced ovarian cancer. Patients were randomly assigned to receive either primary cytoreductive surgery followed by six cycles of intravenous chemotherapy (n = 345), or three cycles of neoadjuvant chemotherapy, interval cytoreductive surgery, and three more cycles of neoadjuvant chemotherapy (n = 343). As long as selection criteria were similar for both arms, maintenance treatment with bevacizumab or a PARP inhibitor was allowed. The primary endpoint was overall survival, with secondary endpoints being progression-free survival and surgical complications. 

In the primary cytoreductive group, 61.7% of patients achieved complete resection, with a median progression-free survival of 22.2 months, compared to 72% and 19.7 months in the interval cytoreductive surgery group (hazard ratio = 0.80 95% confidence interval = 0.66–0.96; P = .02). The median overall survival was 54.3 months for patients who received primary cytoreductive surgery, and 48.3 months for those who received cytoreductive surgery.  

The authors found that patients with complete cytoreduction after primary cytoreductive surgery had the most favorable outcomes. All subgroups showed long-term benefit from primary cytoreductive surgery, particularly patients with stage III ovarian cancer. Furthermore, postoperative complication rates for both groups were acceptable, with a 30-day postoperative mortality rate of < 1%. 

Disclosures: The study authors reported no conflicts of interest.

2025 ASCO Annual Meeting

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