The article reviews the recent advances in the biology and therapy of high-grade serous ovarian cancer (HGSOC). It highlights the shift in understanding of HGSOC's cell of origin from the ovarian surface epithelium (OSE) to the fallopian tube epithelium (FTE), driven by genome sequencing and the discovery of serous tubal intraepithelial carcinomas (STIC). This shift has led to the development of new experimental models and the identification of key therapeutic targets, such as VEGF-driven angiogenesis and homologous recombination deficiency (HRD). PARP inhibitors (PARPiS) have shown significant clinical benefits for selected patients with BRCA-mutated or HRD tumors, but mechanisms of resistance to PARPiS are also being explored. The article discusses the challenges and unsolved problems in the field, including early diagnosis, treatment options for HR-proficient cancers, and strategies to overcome platinum resistance. It emphasizes the importance of understanding the tumor microenvironment and immune response in HGSOC, as well as the need for further research to improve outcomes for patients with advanced-stage disease.The article reviews the recent advances in the biology and therapy of high-grade serous ovarian cancer (HGSOC). It highlights the shift in understanding of HGSOC's cell of origin from the ovarian surface epithelium (OSE) to the fallopian tube epithelium (FTE), driven by genome sequencing and the discovery of serous tubal intraepithelial carcinomas (STIC). This shift has led to the development of new experimental models and the identification of key therapeutic targets, such as VEGF-driven angiogenesis and homologous recombination deficiency (HRD). PARP inhibitors (PARPiS) have shown significant clinical benefits for selected patients with BRCA-mutated or HRD tumors, but mechanisms of resistance to PARPiS are also being explored. The article discusses the challenges and unsolved problems in the field, including early diagnosis, treatment options for HR-proficient cancers, and strategies to overcome platinum resistance. It emphasizes the importance of understanding the tumor microenvironment and immune response in HGSOC, as well as the need for further research to improve outcomes for patients with advanced-stage disease.