Endocrine therapy remains the backbone for treatment of hormone receptor-positive breast cancer in the metastatic setting. Despite the effectiveness of endocrine therapy, primary and acquired endocrine resistance continue to be important clinical challenges. The landscape of metastatic breast cancer treatment has changed considerably with the incorporation of novel agents, including cyclin-dependent kinase 4/6 and mammalian target of rapamycin inhibitors. This article reviews current endocrine treatment strategies and recent and ongoing studies of combination therapies in metastatic hormone receptor-positive, HER2-negative breast cancer.