Tailoring adjuvant endocrine therapy in early breast cancer: When, how, and how long?

•Adjuvant endocrine therapy represents the cornerstone for the management of hormone receptor positive, HER2 negative early breast cancer.•Five years of therapy with tamoxifen represent the standard of care for low-risk peri/premenopausal patients.•The combination of ovarian suppression with tamoxifen or an aromatase inhibitor should be considered for high-risk peri/premenopausal patients.•Postmenopausal patients, should receive an upfront aromatase inhibitor.•To high-risk patients, an extended strategy can be proposed both in the peri/premenopausal and postmenopausal settings with the addition of abemaciclib. Endocrine therapy represents the gold standard for the adjuvant treatment of luminal-like early breast cancer, but its personalization is still a major point of debate. To define the most appropriate therapeutic strategy, both the patient’s menopausal status at the moment of diagnosis and the individual risk of disease recurrence should be taken into account. Five years of therapy with tamoxifen represent the standard of care for low-risk pre/perimenopausal patients, whilst the combination of ovarian suppression with tamoxifen or an aromatase inhibitor should be considered for high-risk patients. Also, to high-risk patients, an extended strategy can be proposed. Postmenopausal patients, instead, should receive an upfront aromatase inhibitor and an extended strategy can be considered for a high risk of disease recurrence. Aim of this review is to set a focus on the major studies investigating the optimal type and duration of adjuvant endocrine therapy and evaluate emerging options.