Metastatic breast cancer is incurable, However, the use of different therapeutic modalities like endocrine therapy, chemotherapy, surgery and radiotherapy can effectively palliate symptoms and, under the best of circumstances, prolong life. When systemic treatment is indicated, endocrine therapy should be used first in most cases. This is especially true for estrogen- and progesterone-receptor-positive tumors with relative good prognosis. If one endocrine therapy is effective, there is a high probability that the following endocrine steps will be effective too. Consequently, after initial response to an endocrine treatment, in case of progress, another endocrine therapy should be used. Chemotherapy is indicated in acute life-threatening disease like extensive visceral disease or if endocrine treatment was not effective. The use of surgery and radiotherapy as local therapies should always be considered, if metastasis is limited to only one site (not liver metastasis) or in cases of impending complications like pathological bone fractures.