Laura Esserman, MD, MBA, of the UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA talks about neoadjuvant therapy at at the 2016 World Congress on Controversies in Breast Cancer (CoBrCa) in Barcelona, Spain. She explains that neoadjuvant therapy is the idea that if someone is at risk of having their cancer come back in the rest of their body (known as systemic recurrence), instead of giving the chemotherapy or the hormone therapy after the surgery, they would benefit from being given the therapy before surgery. The basis of that is that if someone is going to get systemic therapy, it is always better to be given the therapy first because it gives a chance to really understand the response to therapy; it can improve a woman’s options for therapy if they have a good response, and also improve their chance of getting different types of treatments or joining a trial if they have a poor response. It is great news if they have a great response and if they do not have a good response, it gives them a chance to do something before they have a recurrence to reduce that risk. Furthermore, she talks about a trial called the I-SPY trial (NCT01042379), which harnesses the neoadjuvant setting to really think about how new agents can be brought into the clinic for testing sooner to accelerate the pace of change, and to dramatically shorten the time interval to get effective agents. She explains that the aim is to change the drug development process and rapidly improve the options available for women.