Neoadjuvant therapy

Summary Neoadjuvant therapy (NAT) for early breast cancer was first introduced in the 1980s to downstage large, inoperable tumors, and thereby enable less extensive surgical resections. Beyond its surgical benefits, NAT offers the unique advantage of assessing treatment response in vivo, informing subsequent adjuvant strategies, and—most importantly—improving long-term outcomes. In certain molecular subtypes, NAT can induce high rates of pathologic complete response, offering the possibility of complete eradication and potential cure of early breast cancer. As a result, NAT is now increasingly used even in patients with smaller breast tumors. Over recent decades, the therapeutic landscape has expanded considerably: HER2-targeted agents and immune checkpoint inhibitors have transformed the management of HER2-positive and triple-negative breast cancer, respectively. Moreover, combining chemotherapy with immune checkpoint inhibition appears to significantly increase pathologic complete response rates in patients with high-risk, hormone receptor-positive breast cancer exhibiting high programmed death ligand 1 (PD-L1) expression. This short review aims to provide an overview of the growing complexity and evolving role of neoadjuvant treatment strategies in early breast cancer.