A major challenge for the clinician in treating patients with metastatic breast cancer is to achieve the best tumor response with the least toxicity. A number of different clinical situations present, and several options for interventions are available. In addition, patients with metastatic disease are candidates for newer approaches. Currently, intensive chemotherapy with the potential goal of cure has been enthusiastically received; however, in most patients, the goal is palliation. Achieving this goal requires an understanding of the natural history of breast cancer and of the patient and her needs.