The management of locally advanced
breast cancer (LABC) remains a major clinical issue, despite progress achieved in diagnosis and
therapy. Preoperative or
neoadjuvant therapy has gained interest since
breast cancer has been regarded as a systemic disease. Comparing adjuvant versus
neoadjuvant treatment, the neoadjuvant approach offers the advantage of downstaging the disease and testing the efficacy of
therapy administered to patients. A large number of clinical trials have attempted to define the optimal
neoadjuvant treatment, but little attention has been paid to the sequence of
chemotherapy. Moreover, the integration of
antibodies against Human Epidermal Receptor-2 (HER-2) and other
biological therapies that may improve the long-term control of
breast cancer patients, have a special clinical interest. In this review, we will discuss these topics attempting to answer the questions why, when and which regimen to use for patients with LABC. Especially, the introduction of the platina derivatives in neoadjuvant trials with their exceptional high pathological complete response rates are challenging to rethink the optimal treatment options in early and locally advanced
breast cancer.