According to the WHO World Cancer Report, 2003, breast cancer is a global public health burden with more than one million new cases diagnosed worldwide each year. Despite the diminished frequency of advanced-stage disease at initial diagnosis in some parts of the world, a significant proportion of women with early-stage disease eventually experience distant recurrences. Metastatic breast cancer is generally incurable and treatment is aimed at extending survival and improving quality-of-life. Efforts to optimize these paradigms are ongoing. In the last 30 years, significant innovations in drug delivery, scheduling and biologic therapies have resulted in significant improvements in disease-specific outcomes in the metastatic setting. One hopes that ongoing innovations, particularly in targeted therapy, will continue to translate into further improvements in this population.