Breast cancer is the most common malignancy in women. Although the 5-year overall survival (OS) rate for early-stage breast cancer has now increased to more than 85% and become curable, about 20-30% of patients still become advanced breast cancer. Recurrent metastatic breast cancer (MBC) is still an incurable disease that requires long-term treatment and disease progression after cessation of treatment. The aim of treatment is to reduce symptoms, improve quality of life and prolong survival, thus the concept of total management is very important. Therefore, the whole management concept is very important. From the diagnosis of early-stage breast cancer, doctors should develop a long-term systematic individual management plan, including surgery selection, preoperative and postoperative systemic treatment, patient follow-up, and compliance management, so that early-stage patients can achieve the maximum possible cure, and at the same time, the risk of recurrence should be predicted and possible post-recurrence management should be evaluated. In this article, we will discuss the concept of “advanced breast cancer management”. Based on the concept of “chronic disease” and “maintenance treatment” for advanced breast cancer, we propose a treatment model that is more consistent with the goal of “chronic disease” treatment, namely “advanced breast cancer management”. In other words, for patients who are suitable for chemotherapy, after six to eight cycles of first-line chemotherapy, we propose effective maintenance treatment to delay recurrence, replacing the original “stop chemotherapy and wait for recurrence” treatment model. The treatment mode of “stopping chemotherapy and waiting for recurrence” is replaced by a “long flow” treatment strategy to achieve the goal of “prolonging life”. Of course, the whole management treatment model also includes endocrine therapy and maintenance therapy after the effective treatment with targeted drugs. Although there is no data to support the maintenance treatment after the effective endocrine therapy, it has become the empirical consensus of clinical experts. Targeted drugs combined with chemotherapy can also theoretically be used as maintenance therapy after effective treatment, but the price factor makes it difficult to be used routinely in the clinical setting with limited medical resources. The following three points should be understood regarding the treatment model for the whole management of advanced breast cancer in chemotherapy patients: ① Advanced breast cancer should be treated as a “chronic disease”, that is, when formulating the treatment plan for advanced breast cancer, not only the first-line chemotherapy regimen should be considered, but also the maintenance chemotherapy after the first-line treatment is effective, that is, the concept of “first-line + maintenance” should be established. ＋(2) Breast cancer treatment mostly adopts continuous maintenance therapy, that is, after the combination chemotherapy is effective, one of the effective drugs should be used for maintenance therapy, therefore, when formulating the combination regimen, consideration should be given to include drugs suitable for follow-up maintenance therapy; (3) Antitumor treatment is long-term, and patient compliance is the basis for the effect of drugs, therefore, the ideal choice of maintenance chemotherapy should be single-agent chemotherapy. Therefore, the ideal choice of maintenance chemotherapy should be drugs that are effective in monotherapy, relatively low toxicity and easy to use for a long time, such as oral chemotherapy drug capecitabine. The best first-line treatment can be endocrine therapy, chemotherapy and molecular targeted therapy, and reasonable maintenance therapy can be considered for those who are effective. For human epidermal growth factor receptor 2 (HER2) receptor-positive patients, trastuzumab-based therapy until disease progression has become the consensus; for hormone receptor [estrogen receptor (ER) and/or progesterone receptor (PR)] positive patients with slow disease progression, no visceral metastases or asymptomatic visceral metastases, endocrine therapy may be preferred until progression; and for the most commonly seen clinically hormone receptor-negative, hormone receptor-positive but symptomatic visceral metastases, or hormone receptor-positive but with rapid disease progression or ineffective to endocrine therapy, chemotherapy should be considered first. How to manage patients who need to be considered for chemotherapy first throughout the course is an important issue for clinicians. The choice of regimen is an important part of the whole management of patients, and the following factors should be considered: ① Reasonable choice of single agent chemotherapy and combination chemotherapy. For young patients with rapid disease progression, large tumor load and good general condition, combination chemotherapy can be chosen, while for elderly patients with slow disease progression, small tumor load and poor general condition, single agent chemotherapy should be considered. For patients who need combination chemotherapy, the concept of “first-line + maintenance” should be established, and the best first-line combination chemotherapy regimen and follow-up maintenance chemotherapy regimen should be selected. The choice of first-line chemotherapy for advanced breast cancer is influenced by many factors, including the patient’s age at metastasis, physical condition, previous disease, MBC disease status, interval without disease progression, and the patient’s wishes. In addition, two important factors should be considered: the status of prior adjuvant therapy and suitability for subsequent long-term maintenance therapy. In recent years, the landscape of first-line treatment options for advanced breast cancer has changed with the widespread use of anthracyclines and paclitaxel drugs in adjuvant therapy. Anthracyclines are one of the cornerstone agents in breast cancer treatment, but with the widespread use of anthracyclines in adjuvant therapy, the vast majority of patients have already received approximately 3-6 cycles of anthracyclines during the adjuvant chemotherapy phase, and cumulative cardiotoxicity has limited their choice in first-line regimens for advanced breast cancer. Capecitabine single-agent or combination regimens represent an advantage in first-line options for advanced breast cancer due to their efficacy and better cardiac and hematologic toxicity profile. Two randomized controlled phase III clinical studies for the treatment of first-line advanced breast cancer showed similar OS rates with capecitabine in combination with docetaxel (XT) regimens and epirubicin in combination with docetaxel (ET) regimens, but grade 1-2 cardiotoxicity occurred in 9% of patients in the ET group, whereas no cardiac adverse events occurred in the XT group, and the hospitalization rate for handling toxic reactions was lower in the XT group than in the ET group (5% vs. 13%. Capecitabine in combination with paclitaxel (XP) compared with epirubicin in combination with paclitaxel (EP) also showed similar OS rates in the first-line treatment of advanced breast cancer in both regimens, but 2 patients in the EP group discontinued treatment due to cardiotoxicity, whereas no adverse cardiac events were reported in the XP group. These findings suggest that XT or XP regimens can replace ET or EP regimens as the first-line standard of care for patients with advanced breast cancer previously treated with anthracyclines as first-line therapy. For patients who have failed paclitaxel therapy, capecitabine has been approved for the treatment of advanced breast cancer after paclitaxel therapy failure in more than 80 countries and regions worldwide. A phase II study showed that capecitabine combined with vincristine (XN) had a 90% overall clinical benefit rate and good safety profile in the first-line treatment of advanced breast cancer, which provides an effective treatment for patients with first-line advanced breast cancer previously treated with paclitaxel. In patients with HER2-positive advanced breast cancer, a phase II randomized controlled clinical study (CHAT) showed that adding capecitabine (HTX) regimen to trastuzumab combined with docetaxel (HT) regimen significantly extended the time to disease progression (TTP) from 13.6 months to 18.6 months (P=0.029) without a no significant increase in adverse cardiac and hematologic events. Data reported by Verma et al. at the 2010 annual meeting of the European Society of Medical Oncology (ESMO) showed that between 2002 and 2009, the proportion of anthracyclines in Europe as a first-line option for advanced breast cancer decreased from 41% to 21%, paclitaxel remained at 50% for 8 years, while the proportion of capecitabine in first-line treatment of MBC increased from 4% to 20% and the proportion of vincristine decreased from 15% to 20%. The proportion of reserpine declined from 15% to 10%, and gemcitabine remained at a low level of 3%. In addition to adjuvant chemotherapy, the choice of first-line regimen for advanced breast cancer should take into account the suitability for subsequent long-term maintenance use. Not all breast cancer chemotherapy drugs alone are suitable for maintenance therapy. The “Principles of Chemotherapy for Recurrent Metastatic Breast Cancer” published by the Breast Cancer Committee of the Chinese Anti-Cancer Association states that the ideal choice for maintenance chemotherapy should be monotherapy that is effective, relatively low in toxicity, and easy for long-term use, such as the oral chemotherapy drug capecitabine. The major studies on single-agent breast cancer maintenance therapy include: (1) the GEICAM 2001-01 study to evaluate the efficacy of polyethylene glycol liposomal doxorubicin (PLD) for maintenance therapy in advanced breast cancer. The study used doxorubicin or epirubicin sequential paclitaxel regimen (A→T) as the first-line treatment, and then divided into maintenance and observation groups. The results showed that PLD maintenance therapy significantly prolonged median progression-free survival (PFS) (16.04 months versus 9.96 months, P=0.0001). However, considering the route of administration, ease of use and price of PLD, it is difficult to be widely used in clinical practice. ②The MANTA1 study evaluating paclitaxel for maintenance treatment of advanced breast cancer. In this study, 459 patients with recurrent MBC received first-line doxorubicin or epirubicin combined with paclitaxel regimen (AT) chemotherapy for 6 to 8 cycles and were randomized into paclitaxel maintenance therapy and observation groups. Interim analysis showed that patients in the paclitaxel maintenance treatment and observation groups had PFS of 8 and 9 months, respectively, with no statistical difference, indicating that no PFS and OS benefit was achieved with first-line anthracycline combined with paclitaxel chemotherapy followed by 8 cycles of paclitaxel maintenance treatment. (iii) Studies evaluating capecitabine for maintenance therapy. Capecitabine alone has a median PFS of 6 months and OS of 24 months for first-line treatment of advanced breast cancer, with better efficacy than gemcitabine and vincristine alone, low hematologic and cardiotoxicity, and is currently the only orally available chemotherapeutic agent for breast cancer that is suitable for long-term use, as well as being the ideal maintenance chemotherapy agent recommended by the Breast Cancer Specialty Committee of the Chinese Anti-Cancer Association. In a phase III prospective randomized controlled study, the OS of capecitabine monotherapy was better than that of a three-drug combination of cyclophosphamide, methotrexate and fluorouracil (CMF), which may be related to the suitability of capecitabine for long-term use. Thus, the combination of definitive efficacy, good safety profile and oral convenience makes the capecitabine combination therapy followed by capecitabine monotherapy maintenance (X-Based X) regimen a more reasonable choice for the whole management treatment modality. The concept of “advanced breast cancer management” is a further improvement of the concept of advanced breast cancer treatment after “chronic disease” treatment and “maintenance treatment”. In addition to choosing the best first-line treatment plan and considering the ideal maintenance drugs, the management of patient compliance is also crucial. Due to the established efficacy, better safety and unique oral application, capecitabine combined with chemotherapy followed by capecitabine monotherapy maintenance therapy provides a reasonable treatment plan for the management of advanced breast cancer.