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TRUST: Trial of Radical Upfront Surgical Therapy in advanced ovarian cancer (ENGOT ov33/AGO‐OVAR OP7)
  1. Alexander Reuss1,
  2. Andreas du Bois2,
  3. Philipp Harter2,
  4. Christina Fotopoulou3,4,
  5. Jalid Sehouli4,
  6. Giovanni Aletti5,
  7. Frederic Guyon6,
  8. Stefano Greggi7,
  9. Berit Jul Mosgaard8,
  10. Alexander Reinthaller9,
  11. Felix Hilpert10,
  12. Carmen Schade-Brittinger1,
  13. Dennis S Chi11 and
  14. Sven Mahner12
  1. 1 AGO Study Group and Coordinating Centre for Clinical Trials, Philipps-Universität Marburg, Marburg, Germany
  2. 2 AGO Study Group and Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte Evangelische Huyssens-Stiftung/Knappschaft GmbH, Essen, Germany
  3. 3 AGO Study Group and West London Gynecological Cancer Centre; Imperial College Healthcare NHS Trust, London, UK
  4. 4 AGO Study Group and Department of Gynecologic Oncology, Charite Comprehensive Cancer Center Berlin, Berlin, Germany
  5. 5 MANGO and Department of Gynecology, Istituto Europeo di Oncologia, Milano, Italy
  6. 6 GINECO and Institut Bergonie, Bordeaux, France
  7. 7 Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
  8. 8 NSGO and Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  9. 9 Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
  10. 10 AGO Study Group and Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
  11. 11 AGO Study Group and Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  12. 12 AGO Study Group and Department of Obstetrics and Gynecology, University Hospital, Ludwig Maximilians University Munich, Munich, Bayern, Germany
  1. Correspondence to Alexander Reuss, Coordinating Centre for Clinical Trials, Philipps-Universität Marburg, Marburg 35043, Germany; alexander.reuss{at}


Background Primary cytoreductive surgery followed by chemotherapy has been considered standard management for patients with advanced ovarian cancer over decades. An alternative approach of interval debulking surgery following neoadjuvant chemotherapy was subsequently reported by two randomized phase III trials (EORTC‐GCG, CHORUS), which were criticized owing to important limitations, especially regarding the rate of complete resection.

Primary Objective To clarify the optimal timing of surgical therapy in advanced ovarian cancer.

Study Hypothesis Primary cytoreductive surgery is superior to interval cytoreductive surgery following neoadjuvant chemotherapy for overall survival in patients with advanced ovarian cancer.

Trial Design TRUST is an international open, randomized, controlled multi-center trial investigating overall survival after primary cytoreductive surgery versus neoadjuvant chemotherapy and subsequent interval cytoreductive surgery in patients with FIGO stage IIIB–IVB ovarian, tubal, and peritoneal carcinoma. To guarantee adequate surgical quality, participating centers need to fulfill specific quality assurance criteria (eg, ≥50% complete resection rate in upfront surgery for FIGO IIIB–IVB patients, ≥36 debulking-surgeries/year) and agree to independent audits by TRUST quality committee delegates. Patients in the primary cytoreductive surgery arm undergo surgery followed by 6 cycles of platinum-based chemotherapy, whereas patients in the interval cytoreductive surgery arm undergo 3 cycles of neoadjuvant chemotherapy after histologic confirmation of the disease, followed by interval cytoreductive surgery and subsequently, 3 cycles of platinum-based chemotherapy. The intention of surgery for both groups is complete tumor resection according to guideline recommendations.

Major Inclusion/Exclusion Criteria Major inclusion criteria are suspected or histologically confirmed, newly diagnosed invasive epithelial ovarian cancer, fallopian tube carcinoma, or primary peritoneal carcinoma FIGO stage IIIB–IVB (IV only if resectable metastasis). Major exclusion criteria are non-epithelial ovarian malignancies and borderline tumors; prior chemotherapy for ovarian cancer; or abdominal/pelvic radiotherapy.

Primary Endpoint Overall survival.

Sample Size 772 patients.

Estimated Dates for Completing Accrual and Presenting Results Accrual completion approximately mid-2019, results are expected after 5 years' follow-up in 2024.

Trial Registration NCT02828618.

  • interval debulking surgery
  • neoadjuvant chemotherapy
  • ovarian cancer
  • primary debulking surgery

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  • Contributors Substantial contributions to the conception or design: all authors. Drafting the work or revising it critically for important intellectual content: all authors. Final approval of the version published: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

  • Funding The trial is supported through internal resources of the AGO study group and in parts by Roche and Astra Zeneca.

  • Competing interests AdB reports personal fees from Roche, Astra Zeneca, BIOCAD, Genmab, Clovis, Tesaro, PharmaMar, Pfizer, outside the submitted work. PH reports grants and personal fees from Astra Zeneca, Roche, Tesaro, Public funding (ASCO, DKH, DFG), personal fees from Sotio, Stryker, Zai Lab, MSD, Clovis, Immunogen, grants from GSK, Boehringer Ingelheim, Medac, Genmab, outside the submitted work. CF reports personal fees from Roche, Tesaro, Astra Zeneca, Olympus, Ethicon, outside the submitted work. A Reinthaller reports research grants from Roche; honoraria as a speaker and for advisory boards from Amgen, Astra Zeneca, MSD, PharmaMar, Roche, Tesaro, Vifor Pharma; travel expenses from Amgen, Astra Zeneca, PharmaMar, Roche, Tesaro. FH reports personal fees from Astra Zeneca, Roche, PharmaMar, Tesaro, Clovis, outside the submitted work. DSC reports personal fees from Bovie Medical Co., Verthermia Inc. (now Apyx Medical Corp.), C Surgeries, Biom ‘Up, other from Intuitive Surgical, Inc., TransEnterix, Inc., outside the submitted work. SM reports grants and personal fees from AstraZeneca, Medac, MSD, PharmaMar, Roche, Tesaro, Teva, personal fees from Clovis, Novartis, Olympus Europa, Sensor Kinesis, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.