When considering the best overall management strategy of recurrent granulosa cell tumors (GCT), given the long survivals and multiple recurrences many patients will experience, chemotherapy is an important component of overall treatment. The recommended first-line chemotherapy regimen includes BEP (bleomycin, etoposide, and cisplatin) and more recently carboplatin and paclitaxel. While chemotherapy has not shown strong OS benefit, the extension of PFS is meaningful and can lead to longer intervals between surgery and perhaps an overall decrease in the total number of surgeries a patient has in their lifetime. There is ongoing research to better understand the various systemic treatment approaches for GCT, bevacizumab, hormonal therapies, and immunotherapy. Overall, a multimodal approach is essential for the effective treatment of recurrent GCT with systemic chemotherapy being an important part of the treatment paradigm for this tumor.