Abstract: Hormone receptor-positive/HER-2-negative (HR+/HER2-) breast cancer exhibits low sensitivity to neoadjuvant chemotherapy (NCT); with minimal benefits observed from NCT. Neoadjuvant endocrine therapy (NET) achieves a clinical response comparable to that of NCT, but with lower toxicity. In addition, CDK4/6 inhibitors have changed the treatment landscape of HR+/HER2-breast cancer, raising new clinical challenges in the selection of the most effective endocrine therapies. In clinical practice, adaptive research designs should be adopted based on tumor biology, therapeutic efficacy, and tumor burden. In addition, optimizing treatment strategies and performing precise treatment is important. In this review, we discuss the application value of NET, efficacy evaluating and predicting methods, and potential NET-based combination therapies to provide reference information regarding the treatment of HR+/HER2- breast cancer for clinicians.