Peripheral T cell lymphomas (PTCL), non-Hodgkin lymphomas characterized by having features of T cells that have matured in the thymus, are a heterogeneous group of clinical entities. Compared with B cell lymphomas, they are less common, more difficult to diagnose and classify, more aggressive, and have inferior outcomes with current treatment paradigms. They are also less completely understood in terms of how different PTCL types correspond to normal T cell development, and in identifying cell signaling pathways as targets for new therapies. Recent studies with novel targeted therapies as single agents or in combination with other drugs have illustrated promising outcomes both for relapsed and frontline PTCL. We first briefly review classification, prognostic indices, and results of initial therapy of various T cell lymphomas. We then review recent studies of chemotherapy, monoclonal antibody-based therapy directed at cell surface targets, small molecule inhibitors of intracellular targets such as histone deacetylases and the proteasome, and agents that disrupt stromal interactions. Investigations that enhance our knowledge of T cell molecular biology and integrate novel targeted agents into the treatment algorithm for PTCL will be keys to improved outcomes for patients with PTCL.