Hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer represents a significant clinical challenge, particularly in locally advanced stages. Neoadjuvant endocrine therapy (NET) has emerged as a crucial strategy to downstage tumors, aiming to facilitate breast-conserving surgery (BCS) in patients who are unsuitable for or decline chemotherapy. The Phase II CARMINA02 trial was designed to evaluate and compare the therapeutic utility, safety, and surgical conversion potential of two distinct endocrine agents, fulvestrant (a selective estrogen receptor degrader) and anastrozole (an aromatase inhibitor), administered in the preoperative setting. This study highlights the ongoing efforts to optimize preoperative endocrine blockade for postmenopausal women with advanced operable disease.