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Summary Metastatic breast cancer remains incurable. Goals of therapy include tumor shrinkage, symptom control, delay of disease progression and prolongation of survival while maintaining an acceptable quality of life. In case of hormone receptor positive status, non visceral and slowly progressing disease, endocrine therapy is the treatment of choice. Several endocrine agents are currently available including selective estrogen receptor (ER) modulators (tamoxifen), aromatase inhibitors (anastrozole, letrozole and examestane) as well as the selective ER down-regulator, fulvestrant. Chemotherapy has to be preferred in case of hormone receptor negative or rapidly progressive visceral disease regardless of hormone receptor status. Effective agents include taxanes, anthracyclines, vinorelbine, capecitabine, gemcitabine. Combi nation regimens generally result in higher response rates and prolonged time to progression compared with sequential single agents; unfortunately, survival is rarely prolonged and toxicity is higher. This approach should be recommended in young patients with good performance status and visceral disease. Single agents have a better tolerability profile and should be the treatment of choice when a balance between activity and tolerability is needed. In case of HER-2 positive tumors, chemotherapy plus trastuzumab is significantly superior to chemotherapy alone both in terms of response rate and survival and is currently the treatment of choice for these patients. Other target-specific agents targeting the HER- family and vascular endothelial growth factor are currently under investigation.
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