This activity examines evidence-based selection and management of adjuvant systemic therapy for patients with high-risk HR-positive/HER2-negative early breast cancer, with emphasis on recurrence risk stratification, eligibility for CDK4/6 inhibitors, and treatment tolerability. The expert discussion highlights long-term distant recurrence risk after endocrine therapy and phase III data from monarchE and NATALEE, including survival, patient selection criteria, treatment duration, and distinct safety profiles for adjuvant abemaciclib and ribociclib. It also addresses emerging phase III evidence for the oral SERD giredestrant. Practical case-based scenarios highlight how anatomic stage, nodal status, tumor grade, Ki-67, genomic risk, BRCA status, guideline criteria, toxicity profiles, and patient preferences influence treatment choice, and additional content focuses on monitoring and managing adverse events to support dose optimization and adherence.