Contemporary management of recurrent ovarian, primary peritoneal, and fallopian tube cancers has continued to evolve and now offers women the hope of extended survival with an improved quality of life. Platinum continues to be the single most active agent in the treatment of ovarian cancer, but acquired resistance to platinum often emerges. Fortunately, a number of novel agents and treatment strategies have been developed to meet the goals of ameliorating symptoms while extending survival. Classically, patients have been treated based upon the interval from last platinum administration during front-line therapy until time of recurrence. This review focuses upon the current treatment strategies used for platinum-refractory, platinum-resistant, and platinum-sensitive patients. The incorporation of targeted biologic agents is also discussed, along with the role of secondary cytoreduction. It is hoped that the results of future and ongoing clinical trials will offer further advances in the treatment of this devastating disease.