Background: Neoadjuvant chemotherapy (NACT) has become a standard treatment for patients with locally advanced, high grade, HER2-positive, and TNBC. Hormone receptor-positive/HER2-negative breast cancer sensitivity to NACT is low, with lower pCR rates. Neoadjuvant chemo-endocrine therapy may become a new strategy to improve pCR in HR-positive/HER2-negative patients. We conducted a randomized trial to assess efficacy of neoadjuvant chemo-endocrine therapy vs chemotherapy in hormone positive, HER.2 negative breast cancer. Method: premenopausal females with stage II-III, ER-positive, HER.2-negative, invasive breast cancer (n: 152) were randomly assigned (1:1) to received neoadjuvant chemotherapy or chemo-endocrine therapy. The primary objective was pCR. The secondary objectives included tumor downstaging to conservative breast surgery, adverse events, and DFS. Results: there was significant increase in frequency of complete, marked and partial pathological response in chemo-hormonal group (p <0.001), significant reduction of radiological LN(s) size in chemo-hormonal group (P =0.046), a significant reduction of ki67 level after treatment in both groups (p <0.001), a more significant reduction was in chemo-hormonal group (P =0.022). Event free survival (EFS) estimates 94.7% at 20 months interval and 82.7% at 40 months interval in chemotherapy group, also EFS estimates 97.1% at 20 months interval and 92.8 % at 40 months interval in chemo-hormonal group with near significant difference between 2 groups (P =0.074). No significant difference in OS at 20 and 40 months between both groups (P =0.163). Conclusions: neoadjuvant chemo-endocrine therapy significantly improves pCR, radiologic tumor downstaging, decrease ki67, and EFS compared with chemotherapy in HR-positive, HER2-negative breast cancer.