To discuss the implications and outcomes of the TRUST trial comparing primary debulking surgery with neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer, focusing on survival rates and patient selection criteria.
Key Findings:
The TRUST trial did not meet its primary endpoint of overall survival (54.3 vs 48.3 months; HR 0.89; p=0.24), indicating a need for further investigation into treatment strategies.
Progression-free survival significantly favored primary debulking surgery (22.2 vs 19.7 months; HR 0.80; p=0.02), suggesting potential benefits in specific patient populations.
The trial had limitations including inadequate surgical candidate selection, reliance on overall survival as the sole primary endpoint, and underpowered subgroup analyses, which may affect the interpretation of results.
Interpretation:
The debate highlighted that neither treatment approach should be considered universally superior, emphasizing the need for careful patient selection based on validated criteria and the importance of surgical expertise in achieving optimal outcomes.
Limitations:
Inadequate selection tools for primary debulking surgery eligibility, which may have impacted trial outcomes.
Overall survival as the sole primary endpoint may obscure benefits of treatment, particularly in a population with varied post-progression survival.
High heterogeneity in FIGO stage IV patients and lack of BRCA/HRD stratification, which are critical for understanding prognosis and treatment response.
Conclusion:
The findings suggest that primary debulking surgery may still offer benefits when reserved for appropriately selected patients, emphasizing the need for centralized care in high-volume centers to ensure optimal patient outcomes.
by Martina Arcieri, Sandro Pignata, Domenica Lorusso, Anna Fagotti, Vito Chiantera, Antonino Ditto, Giorgio Valabrega, Claudia Marchetti, Claudio Zamagni, Valentina Tuninetti, Alberto Farolfi, Stefano Restaino, Giuseppe Vizzielli
