The place of tamoxifen in the treatment of metastatic breast cancer is being challenged by the development of less estrogenic antiestrogens. New inhibitors of aromatase and estrone sulfatase have been reported. Anthrapyrazoles are new cytotoxic agents with high activity and low toxicity. Uncertainty about the optimal duration of chemotherapy continues. Methods to intensify chemotherapy, enabled by bone marrow support techniques, continue to be studied, but a routine role for this approach in palliative treatment of metastatic disease has not been established. Active specific immunotherapy appears to be practicable following identification of defined tumor-associated immunogens. Evidence for the ability of bisphosphonates to reduce morbidity from bone metastases continues to accumulate.