In recent years, the therapeutic landscape for metastatic breast cancer has become much more diverse. Systemic therapy is primarily oriented towards the disease subtype. While hormone receptor expression, human epidermal growth factor receptor (HER2) status, remain decisive factors, other elements, including germline BRCA status (BRCA: breast cancer gene), programmed death-ligand 1 (PD-L1) status, or expression of tumor-specific mutations, have gained importance. In addition to traditional chemotherapies, targeted options or antibody–drug conjugates, which lead to an extension of progression-free and overall survival, are increasingly becoming available. In order to select the optimal therapy sequence for each patient, it is necessary to continuously expand oneʼs own knowledge and to engage in interdisciplinary discussions.