The TRUST trial in ovarian cancer: a missed opportunity or a turning point? The position of the Italian MITO group

Category	Detail
Condition
Key Mechanisms	Comparison of primary debulking surgery vs neoadjuvant chemotherapy followed by interval debulking surgery, emphasizing the trial's findings.
Target Population
Care Setting

Overall survival did not significantly differ between treatment arms (54.3 vs 48.3 months; p=0.24).
Progression-free survival favored primary debulking surgery (22.2 vs 19.7 months; p=0.02), highlighting its clinical relevance.
The trial highlighted the need for objective selection tools for surgical candidates.
Concerns raised about the limitations of overall survival as the sole primary endpoint.
The debate emphasized the importance of expert assessment in treatment selection.

Utilize validated laparoscopic scoring systems for surgical candidate selection, such as the Fagotti Predictive Index Value.

Consider both primary debulking surgery and neoadjuvant chemotherapy based on patient selection criteria.

Assess progression-free survival as a key outcome measure, alongside overall survival.

Avoid excessively aggressive surgery in frail patients or those unlikely to achieve complete resection, to minimize morbidity.

Primary debulking surgery may offer benefits when performed in selected patients with good performance status and resectable disease.

Centralize care in high-volume centers for optimal patient-treatment matching, supported by evidence.
Employ multidisciplinary assessment for treatment planning, ensuring comprehensive care.

Clinical Scorecard: Evaluating the TRUST Trial in Ovarian Cancer: An Analysis by the Italian MITO Group on Its Implications and Outcomes