Estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2 (HER2)−negative advanced or metastatic breast cancer (MBC) is the most common MBC subtype and currently remains incurable, with a median overall survival of 24.8 months (95% confidence interval, 21.3–30.3). Common sites of metastases are bone, viscera, and brain, causing significant symptoms that negatively affect patient functioning, quality of life (QoL), and work productivity. Guidelines state that endocrine therapy (ET) is preferable to chemotherapy as first-line treatment for patients with ER+ MBC, regardless of limited visceral metastases, unless rapid tumor response is required or ET resistance is suspected. Although response rates up to 40% have been reported for first-line MBC treatment, the majority of initial responders eventually develop ET resistance. Notwithstanding the steep decline in efficacy between first and later lines of ET, some patients may receive chemotherapy earlier than necessary. Although new treatments have been approved for patients with ER+/HER2− advanced or MBC in the past decade, neither survival nor QoL appear to have improved significantly. Thus, there remain significant unmet needs for this patient population, including improved survival, maintaining or improving patient QoL, and emphasizing the importance of treatment selection to assist healthcare practitioners managing patient care. In this review, we identify current challenges and unmet needs in this patient population, review cutting-edge treatments, and provide clinically relevant suggestions for treatment selection that can optimize outcomes and patients’ health-related QoL.

雌激素受体阳性（ER +）/人类表皮生长因子受体2（HER2）阴性的晚期或转移性乳腺癌（MBC）是最常见的MBC亚型，目前仍无法治愈，中位总生存期为24.8个月（95％置信度）区间21.3–30.3）。转移的常见部位是骨骼，内脏和大脑，会导致严重症状，对患者的功能，生活质量（QoL）和工作效率产生负面影响。指南指出，对于内脏转移有限的患者，内分泌治疗（ET）优于化学疗法作为ER + MBC患者的一线治疗，除非需要快速的肿瘤反应或怀疑ET耐药。尽管一线MBC治疗的缓解率据报道高达40％，但大多数初始缓解者最终都会产生ET耐药性。尽管在ET的最初和之后的治疗之间药效急剧下降，但某些患者可能比必要的时候更早接受了化疗。尽管在过去的十年中，已批准对患有ER + / HER2−晚期或MBC的患者采用新疗法，但存活率和QoL均未见明显改善。因此，该患者群体仍然存在大量未满足的需求，包括改善生存率，维持或改善患者QoL，并强调治疗选择对协助医护人员管理患者护理的重要性。在这篇综述中，我们确定了该患者人群中当前的挑战和未满足的需求，回顾了最前沿的治疗方法，并为治疗选择提供了与临床相关的建议，这些选择可以优化结果和患者健康相关的QoL。