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Ovarian cancer accounts for more deaths in the United States than all other gynecologic malignancies combined. More than two-thirds of patients are still diagnosed, as they always have been, with advanced stage disease. Traditionally, upfront surgery followed by platinum-based chemotherapy has been the treatment of choice. More recently, the paradigm of care has undergone significant revision as our understanding of this heterogeneous disease continues to evolve. As a result, the way we think about, categorize and approach, the treatment of ovarian cancer is changing rapidly. Increasingly, innovations in targeted therapies appear to be the future. The purpose of this review is to provide an update of current controversies in the field, and to highlight new directions in the management of this insidious disease.