The development of an optimal management approach in recurrent ovarian cancer requires careful consideration of a number of important factors including (a) response to and severity/persistence of toxicity associated with prior therapy, (b) existence of relevant trial data (particularly phase 3 studies), (c) patient interest in participating in clinical trials, (d) cost of (and ability to pay for) particular anti-neoplastic drug regimens, and (e) patient choice. It is likely that the increasing availability of biologically active novel agents (and combination programs) in this clinical setting will add to the difficulty of defining optimal therapy in recurrent/resistant ovarian cancer, which, in many individuals, can be reasonably considered a very serious chronic disease process.