Highlights from ASCO 2025—advances in the treatment of ovarian cancer
- Open Access
- 11.11.2025
- short review
Erschienen in:
Summary
Introduction
Ovarian cancer remains the leading cause of gynecologic cancer-related death in Europe. While advances in cytoreductive surgery and the introduction of maintenance therapies with PARP inhibitors have improved outcomes, optimal treatment strategies continue to evolve. New data presented at the 2025 ASCO Annual Meeting provide further guidance for clinical decision-making. This review focuses on three pivotal studies: TRUST, which evaluated the optimal timing of cytoreduction; FIRST, which investigated immunotherapy in primary advanced ovarian cancer; and ROSELLA, a phase 3 trial exploring a novel combination for platinum-resistant disease.
Optimal timing of primary surgery: TRUST trial
The TRUST trial (ENGOT ov 33/AGO-OVAR OP 7) was a randomized, multicenter phase 3 study to compare primary cytoreductive surgery (PCS) with neoadjuvant chemotherapy followed by interval cytoreductive surgery (NACT/ICS) in patients with stage IIIB–IVB ovarian cancer and good performance status (ECOG 0‑1). The trial enrolled 688 eligible patients, with a strong emphasis on surgical quality: Only expert centers with proven outcomes participated, and complete resection rates of ≥ 50% were mandatory. Maintenance treatment with bevacizumab and/or PARP inhibitors was allowed in both arms.
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Key findings
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Median progression-free survival (PFS) was significantly improved with PCS: 22.2 months vs. 19.7 months (HR: 0.80; p = 0.02).
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Median overall survival (OS) was numerically longer in the PCS arm (54.3 vs. 48.3 months), although this did not reach statistical significance (HR: 0.89; p = 0.24).
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The greatest benefit of PCS was seen in patients with complete cytoreduction (median OS 67.0 vs. 55 months, HR: 0.80; p = 0.05).
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Patients with stage III disease derived the largest survival advantage (median OS PCS vs. ICS: 63.7 vs. 53.2 months).
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Postoperative mortality was < 1%, confirming the safety of surgery in experienced centers.
Conclusion
In non-frail patients with seemingly resectable advanced ovarian cancer, PCS should be performed in expert gynecologic oncology centers. The trial reinforces the role of PCS as standard of care in this population and highlights the importance of achieving complete resection to optimize outcomes.
Emerging role of immunotherapy: FIRST trial
The FIRST trial (ENGOT-OV44) investigated the addition of the anti-PD‑1 antibody dostarlimab to first-line platinum-based chemotherapy and maintenance niraparib (± bevacizumab) in patients with newly diagnosed stage III–IV epithelial ovarian cancer. A total of 1138 patients were randomized. The primary endpoint was investigator-assessed PFS, with OS as a key secondary endpoint.
Key results
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The addition of dostarlimab led to a statistically significant improvement in PFS: 20.6 vs. 19.2 months (HR: 0.85; p = 0.0351).
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No OS benefit was observed at this stage of follow-up (median OS: 44.4 vs. 45.4 months).
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Safety profiles were consistent with expectations for checkpoint inhibitors and PARP inhibitors.
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Conclusion
The FIRST trial is the first positive randomized trial of immunotherapy in primary ovarian cancer. Although the magnitude of PFS benefit was modest, this study paves the way for future trials combining immunotherapy with targeted agents and chemotherapy in this setting. Ongoing studies may help refine patient selection and optimize combination strategies.
A new option for platinum-resistant disease: ROSELLA trial
ROSELLA (ENGOT-ov 72/GOG-3073) was an open-label, randomized phase 3 trial investigating relacorilant, a selective glucocorticoid receptor antagonist, in combination with nab-paclitaxel for platinum-resistant ovarian cancer. Relacorilant aims to overcome chemotherapy resistance mediated by glucocorticoid receptor signaling. The study enrolled 381 patients and showed clear benefits:
Key outcomes
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PFS was significantly improved: 6.54 vs. 5.52 months (HR: 0.70; p = 0.0076).
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OS also improved: 15.97 vs. 11.50 months (HR: 0.69; p = 0.0121).
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Adverse events were consistent across arms, with some increase in hematologic toxicity in the combination arm but no unexpected safety signals.
Conclusion
The combination of relacorilant and nab-paclitaxel offers a new and effective treatment option for platinum-resistant ovarian cancer. The OS benefit is clinically meaningful, and this regimen may soon represent a new standard of care in this difficult-to-treat setting. Studies including bevacizumab are currently recruiting.
Overall conclusion
The ASCO 2025 highlights provide new insights into personalized treatment strategies for ovarian cancer:
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The optimal timing of surgery should be individualized but, where feasible, primary cytoreductive surgery should be pursued in expert centers to maximize patient outcomes.
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Immunotherapy is beginning to show encouraging signals in primary advanced disease, and further positive trials are anticipated.
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Novel agents such as relacorilant, ADCs, and CPI offer new hope for patients with platinum-resistant ovarian cancer.
Conflict of interest
S. Polterauer: Advisor: Abbvie, AstraZeneca, Clovis, Eisai, GSK, MSD, PharmaMar, Roche, Vifor Pharma, Travel Expanses: AstraZeneca, MSD, GSK, Roche.
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