“What makes ROSELLA exciting is that it worked regardless of biomarker status. That’s new in this space”
#ASCO25 was particularly exciting in the field of ovarian cancer. Data was presented showing improved outcomes in both frontline and platinum-resistant settings. touchONCOLOGY Editorial Board member Dr Domenica Lorusso (Director of Gynaecological Oncology Unit at Humanitas Hospital San Pio X, Milan; and Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Milan, Italy) reflects on key data from three studies: a frontline trial of dostarlimab plus chemotherapy and PARP inhibition, the ROSELLA trial in platinum-resistant disease and the long-awaited TRUST trial assessing surgical strategies. While none of the trials were practice-changing, they contribute important data to inform treatment decisions, highlight the need for better biomarkers, and reinforce the importance of patient selection and surgical expertise.
Frontline therapy: Immunotherapy shows promise
ASCO was important for ovarian cancer. We saw results from a frontline trial investigating dostarlimab in combination with chemotherapy – carboplatin and paclitaxel – plus the PARP inhibitor niraparib, with or without bevacizumab (Abstract LBA5506). This was compared with chemotherapy plus PARP inhibitor, again with or without bevacizumab. The trial was well designed, with an appropriate control arm, and it met statistical significance. However, the benefit was modest – a one-month improvement in PFS – and no impact on OS. This reinforces the idea that while some patients may benefit from immunotherapy in this setting, we currently lack robust biomarkers to identify them.
Platinum-resistant disease: ROSELLA brings a breakthrough
In the platinum-resistant setting, the ROSELLA trial (Abstract LBA550) introduced a novel concept. Relacorilant, a glucocorticoid receptor antagonist, was tested in combination with nab-paclitaxel and compared with nab-paclitaxel alone. The combination significantly improved both PFS and OS in platinum-resistant patients. This follows last year’s MIRASOL trial, in which mirvetuximab demonstrated OS benefit in folate receptor–positive tumors. What is notable about ROSELLA is that survival benefit was observed regardless of biomarker status. This represents an important step forward in a setting where, historically, no therapies had demonstrated an OS benefit.
TRUST trial findings in primary vs neoadjuvant surgery
Finally, after many years, we have data from the TRUST trial (Abstract LBA5500), which compared neoadjuvant chemotherapy followed by interval debulking surgery with primary cytoreductive surgery in newly diagnosed ovarian cancer. Earlier trials suggested neoadjuvant chemotherapy as a reasonable alternative to primary surgery but were criticised for inadequate surgical quality and inappropriate patient selection.
TRUST addressed these concerns by enrolling patients who were objectively considered eligible for surgery and by limiting the study to high-volume centres with surgical expertise. Despite this, the trial did not demonstrate superiority of primary surgery in terms of OS. Thus, the trial is negative. However, this does not negate the value of primary surgery in appropriately selected patients.
In a subgroup analysis of patients with stage III disease who achieved complete resection (residual tumor 0), there was a significant improvement in PFS. OS was not significantly different, but in a disease like ovarian cancer – where median survival now exceeds 70 months – demonstrating an OS advantage in frontline trials is increasingly difficult due to the impact of subsequent lines of therapy, including secondary surgery.
Nonetheless, PFS remains a valid surrogate for the immediate benefits of primary surgery. These results underscore the importance of centralising care in referral centres with the experience to determine whether optimal cytoreduction is feasible. For patients in whom complete resection can be achieved with acceptable morbidity, primary surgery remains the preferred approach. For others – where the likelihood of complete resection is low or the potential toxicity too high – neoadjuvant chemotherapy remains a justified alternative.
View full #ASCO25 coverage here!
Disclosures: Domenica Lorusso is a consultant for MSD, GSK, Novartis; she has received grant/research support from Astra Zeneca, Clovis Oncology, Pharmaand Genmab, GSK, immunogen, Incyte, MSD, Novartis, Pharmamar, Roche, Seagen, alkermes and corcept; she is a member of the Advisory Board for Astra Zeneca, clovis oncology, corcept, daiichi sankyo, genmab, gsk, immunogen, msd, abbvie, novartis oncoinvest, novocure, seagen and sutro; she is a Speaker’s Bureau participant with Astra Zeneca, clovis oncology, corcept, daiichi sankyo, genmab, gsk, immunogen, msd, abbvie, novartis oncoinvest, novocure, seagen and sutro.
This content has been developed independently by Touch Medical Media for touchONCOLOGY. It is not affiliated with the American Society of Clinical Oncology (ASCO). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Interviewer/Editor: Sophie Nickelson
Cite: #ASCO25: Dr Domenica Lorusso on TRUST, ROSELLA & precision medicine in ovarian cancer. touchONCOLOGY. June 24th, 2025.
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