The introduction of poly (ADP-ribose) polymerase inhibitors (PARPi) into the management of ovarian cancer has transformed the treatment landscape for patients affected by this malignancy. However, as the use of PARPi expands into both frontline maintenance and recurrence settings, the emergence of drug resistance has become a significant clinical challenge in the treatment of these patients. Although platinum-based chemotherapy (PBC) and PARPi act through different mechanisms—PBC causes DNA damage while PARPi blocks its repair—both depend on the integrity of DNA damage repair (DDR) pathways, leading to overlapping mechanisms of resistance. Here, we review the key resistance mechanisms shared by PARPi and PBC, and then we discuss their clinical implications in the management of patients with ovarian cancer. We also examine clinical rationale supporting the hypothesis that prior PARPi exposure may reduce the efficacy of subsequent PBC in patients experiencing a disease recurrence. Furthermore, we review preliminary clinical data assessing the potential role of PARPi retreatment in patients who have previously progressed on PARPis.

Because pelvic malignancies and their treatments often compromise reproductive potential, the need for effective fertility preserving strategies has become increasingly important. Although traditional options offer varying success, most do not aim to maintain uterine reproductive function. Uterine transposition is an innovative surgical technique designed to preserve fertility by safeguarding both the uterus and ovaries in patients undergoing pelvic radiotherapy. This approach involves temporarily repositioning the uterus and ovaries outside the radiation field, with reimplantation after treatment. Since its first successful use in 2015, uterine transposition has been used across different types of cancer and age groups, including prepubertal patients. Early clinical outcomes have been promising, with high rates of ovarian function preservation, menstrual resumption, and successful pregnancies, including spontaneous fertilizations. Additionally, the procedure has demonstrated an acceptable safety profile, with most complications being minor and manageable, although concerns remain regarding uterine ischemia and vascular integrity postreimplantation. The overall findings support its potential as a viable fertility preserving option. However, further research is necessary to refine patient selection, evaluate long-term reproductive outcomes and complications, and address challenges related to uterine perfusion and implantation.

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