Neoadjuvant systemic therapy for early breast cancer

This narrative review summarizes the evolution of neoadjuvant systemic therapy (NAST) in early breast cancer. It traces the shift from surgery-only management to multimodal, biology-driven treatment and discusses the role of NAST across molecular subtypes (HR-positive, HER2-positive, triple-negative), its impact on pCR rates and long-term outcomes. Particular focus is placed on pCR as a decision tool for escalation and de-escalation of systemic and locoregional therapy, contemporary concepts of breast-conserving surgery and axillary staging, and emerging minimally invasive approaches in patients with an exceptional response.