Poly-(ADP)-ribose polymerase (PARP) inhibition is synthetic lethal with deficiency for homologous recombination (HR), a pathway essential for DNA double-strand break repair. PARP inhibitors (PARPi) therefore hold great promise for the treatment of tumors with disruptive mutations in BRCA1/2 or other HR factors. Unfortunately, PARPi resistance has proved to be a major problem in the clinic. Knowledge about PARPi resistance is expanding quickly, revealing four main mechanisms that alter drug availability, affect (de)PARylation enzymes, restore HR, or restore replication fork stability. We discuss how studies on resistance mechanisms have yielded important insights into the regulation of DNA double-strand break (DSB) repair and replication fork protection, and how these studies could pave the way for novel treatment options to target resistance mechanisms or acquired vulnerabilities. Defective DSB Repair and Cancer Genomic instability is one of the enabling characteristics of tumor development [1]. To maintain genomic integrity, cells are equipped with multiple mechanisms to repair a wide variety of DNA lesions caused by exogenous and endogenous events. One particularly toxic lesion is the DNA double-strand break (DSB; see Glossary). This lesion can be caused by ionizing irradiation and genotoxic chemicals, but can also arise as an intermediate of resolving stalled or collapsed replication forks (replication fork instability) [2]. If left unrepaired or are repaired incorrectly, DSBs can give rise to mutations, deletions, amplifications, and chromosomal translocations, leading to various outcomes such as senescence, cell death, or malignant transformation. Over 30 years ago, Marie-Claire King and colleagues discovered the linkage between familial earlyonset breast cancer and the genomic region 17q21 [3]. We now know that the gene affected is BRCA1, and that mutations in this gene are not only linked to breast cancer but also to familial cases of ovarian cancer and sporadic tumors of different origins [4-7]. BRCA1 is an essential factor in the repair of DSBs via homologous recombination (HR) (see Box 1 for a more detailed overview of DSB repair). Moreover, homozygous loss of BRCA1 is not tolerated during human and mouse embryonic development [8]. This BRCA1 survival-dependency can be partially overcome by concomitant loss of p53 [9]. Importantly, mouse models with mammary gland-specific loss of these genes show increased breast tumor formation [8]. Indeed, in clinical tumor samples, BRCA1 mutations often co-occurbut not alwayswith TP53 mutations [8,10]. Epigenetic silencing of BRCA1 expression via promoter hypermethylation is another way of reducing BRCA1 activity, and this has been shown to occur frequently in tumors [6,11,12]. In addition to aberrations in BRCA1, genes encoding many more factors involved in HR, such as BRCA2, PALB2, and RAD51, are known to be affected in a wide variety of tumors. All these tumors display severe chromosomal instability as a result of deregulated HR, a phenotype referred to as 'BRCAne...