The traditional practice of classifying recurrent ovarian cancer as 'platinum-sensitive' or 'platinum-resistant' based on a six-month treatment-free interval is rapidly becoming obsolete. The introduction of maintenance therapies like PARP inhibitors is changing tumor biology and response patterns, suggesting this simple time-based distinction no longer adequately reflects the clinical reality.

Clinicians should view HRD scores as a spectrum rather than a simple positive/negative result. For a patient with a score near the arbitrary cutoff and an excellent clinical response to platinum, oncologists may advocate for insurance coverage of PARP inhibitors.

Final 15-year data from the SOFT/TEXT trials reveal that the survival advantage of adding ovarian function suppression (OFS) to an AI is not uniform. The benefit is most pronounced in the highest-risk premenopausal patients, particularly those under 35 or with grade 3 disease, for whom tamoxifen alone is considered inadequate.

In premenopausal patients, chemotherapy's observed benefit may be an indirect effect of inducing menopause, rather than its cell-killing properties. The ongoing OFFSET trial is testing if optimizing endocrine therapy with ovarian suppression can achieve the same risk reduction as chemotherapy, potentially avoiding chemo's side effects entirely for this group.

As various maintenance therapies (immunotherapy, ADCs) are integrated into endometrial cancer treatment, the next major clinical question is defining how long these agents need to be continued to maximize benefit while minimizing long-term toxicity and patient burden.

Citing powerful long-term data from the SOFT and TEXT trials, some oncologists are leaning away from chemotherapy for premenopausal patients with intermediate Oncotype scores (e.g., <25). They argue that the substantial, proven benefits of ovarian function suppression (OFS) may be equivalent to the chemotherapy benefit seen in trials like TAILORx.

Counterintuitively, the SOFT trial showed pre-menopausal women with BCI-low tumors (less driven by estrogen receptors) derived more benefit from an aromatase inhibitor (AI) plus ovarian suppression compared to tamoxifen. This suggests the most aggressive endocrine therapy is crucial for biologically aggressive, less ER-sensitive cancers.

Unlike some endocrine therapies, oral SERDs used in premenopausal women require concurrent ovarian suppression (e.g., with a GnRH agonist). This is a critical safety measure to mitigate the risk of developing ovarian cysts, a potential side effect of using these agents without adequately suppressing ovarian function.

The initial broad enthusiasm for PARP inhibitors in ovarian cancer has been refined. New data confirms a lack of overall survival improvement for patients with HRD-negative (or HR proficient) tumors, pushing clinicians toward a precision medicine approach where these drugs are reserved for patients with BRCA mutations or HRD-positive disease who are most likely to benefit.