Two recent examples of conventional cytotoxic drugs, taxoids and topo I inhibitors, are set to make a real impact in the treatment of ovarian cancer. However, further progress may depend on novel approaches, focusing on other targets. This review will concentrate on those approaches which have already led to the initiation of clinical trials: agents designed to circumvent cellular drug resistance, signal transduction inhibitors, new hormonal agents, matrix metalloproteinase inhibitors, immunotherapy, immunotoxins and radioconjugates, and intraperitoneal genetic therapy, including the use of replicating viruses. In some cases, early clinical data are encouraging, but ultimately combined treatment with conventional agents may make most impact.