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A great step was taken in the treatment of the prognostically unfavourable group of Her2-positive breast cancer in the past years with the introduction of the targeted therapy with trastuzumab, which showed significant increase in median survival in the metastatic and adjuvant setting of Her2-positive breast cancer patients. Lapatinib, an oral HER2-tyrosine kinase inhibitor, showed activity in patients with breast cancer progression after trastuzumab. The role of lapatinib in the adjuvant setting will be examined in the ongoing, multicenter, prospective, four-arm ALTTO-trial, which compares the current standard treatment of one year trastuzumab against lapatinib, the combination of trastuzumab and lapatinib and an arm with sequential trastuzumab followed by lapatinib. Another promising treatment option is the VEGF-antibody bevacizumab, which blocks tumor-mediated angiogenesis leading to oxygen undersupply and finally growth inhibition of the tumor. Concerning treatment decision, two ongoing prospective trials in the USA and Europe are eagerly awaited, which examine the role of gene-array assessment in terms of risk stratification and finally tailoring adequate treatment.