Rebecca Shatsky, MD; Rita Nanda, MD; Kelly McCann, MD, PhD; Nusayba Bagegni, MD; and Alexis LeVee, MD,discuss how recent advances in hormone receptor–positive breast cancer treatment, including oral SERDs such as elacestrant, PI3K pathway inhibitors, and antibody-drug conjugates such as T-DXd, are being integrated into clinical practice based on biomarkers such as ESR1 mutations and HER2-low expression while addressing key sequencing decisions and resistance mechanisms in the evolving therapeutic landscape.