Introduction. The prognostic and predictive value of gene expression signatures in breast cancer. Systemic Treatments: Targeting ER positive metastatic breast cancer. Targeting HER2+ and Trastuzumab Resistant metastatic breast cancer. Targeting Triple Negative Sporadic and hereditary BRCA related metastatic Breast Cancer. Chemotherapy and metastatic breast cancer. Bisphosphonates and their role in metastatic breast cancer. Targeting Angiogenesis in Metastatic Breast Cancer. Imaging and Response Assessment: Imaging in the management of metastatic breast cancer. Positron emission tomography/computed tomography in metastatic breast cancer. Novel biomarker approaches for improving therapeutic strategies in metastatic breast cancer. Local Treatment Options: Palliative radiotherapy in the management of metastatic breast cancer. Management of neurological complications in metastatic breast cancer. Thoracic complications. Orthopaedic complications. Thermal ablation of hepatic metastases. Palliative Care and Metastatic Breast Cancer. Specialist Support Services and Information Needs for Patients.