Breast cancer incidence in India is rising and presently, incidence is more than cervical cancer in many urban cancer registries. Majority of breast cancer cases in India at presentation are locally advanced, that is large breast tumours (> 5 cm in diameter) with skin or chest wall involvement or with involvement of locoregional lymph nodes. These locally advanced breast cancers are treated with neoadjuvant chemotherapy or chemo-immunotherapy with trastuzumab containing regimen in Her2 Neu positive cases. Neoadjuvant hormonal therapy is considered for those who are elderly or medically unfit/unwilling for chemotherapy and strongly positive for oestrogen/progestrogen receptors. Neoadjuvant chemotherapy does not improve overall or disease-free survival but response to neoadjuvant therapy is the best surrogate prognostic marker.