Endocrine therapy for breast cancer was introduced more than 100 years ago. In the last 30 years, it has been demonstrated that tamoxifen significantly improves outcomes for patients with hormone-responsive breast tumors. Aromatase inhibitors, which suppress the production of estrogen, are recognized today as an KEYWORDS: endocrine therapy, metastatic breast cancer, fulvestrant, endocrine resistance, tamoxifen, aromatase inhibitors.T he influence of ovarian hormones on breast cancer was appreciated first more than 100 years ago, when Beatson demonstrated that inoperable breast tumors regress after oophorectomy. 2 Today, 2 classes of antihormone endocrine agents are considered the standard of care for primary treatment of earlyor late-stage HR1 breast cancer: tamoxifen, which blocks ER activity within tumor cells, and aromatase inhibitors (AIs), such as anastrozole, letrozole, or exemestane, which inhibit the production of estrogen through the aromatase enzyme pathway. Whereas tamoxifen is effective in both premenopausal and postmenopausal women, AIs are indicated only in women who are postmenopausal. In the adjuvant setting, several studies have demonstrated that AIs are tolerated well and offer improved disease-free survival compared with