The TRUST trial, the first phase III randomized study comparing surgical timing in advanced ovarian cancer, demonstrated statistically significant improvement in progression-free survival with primary cytoreductive surgery versus interval surgery (22.1 vs 19.7 months, HR=0.80, P=.018).
Despite improved progression-free survival, the study failed to meet its primary endpoint of overall survival, with median overall survival of 54.3 months for upfront surgery versus 48.3 months for interval surgery (HR=0.89, P=.24).
The trial enrolled 796 patients with FIGO stage IIIB/C or IVA/B ovarian cancer at high-volume centers performing at least 36 primary cytoreductive surgeries annually with complete resection rates of at least 50%.
Complete gross tumor resection was achieved in 70% of primary surgery patients versus 85% of interval surgery patients, with low morbidity rates of 18% and 12% respectively and 30-day mortality rates under 1%.