Systemic treatment is an essential part of medical care in patients with early breast cancer. Breast cancer subtypes differ in biological features and therefore require different therapeutic approaches: in triple-negative and HER2-positive breast cancers, neoadjuvant systemic treatment is standard of care. While taxane- and anthracycline-based chemotherapy is well established in triple-negative breast cancer, the addition of immune checkpoint inhibitors based on recent studies is becoming the new standard. In HER2-positive breast cancer, there is clear evidence for the use of neoadjuvant chemotherapy in combination with the HER2-antibodies trastuzumab and pertuzumab. In luminal cancers, neoadjuvant treatment is focused on downsizing to improve breast-conserving surgery. Besides chemotherapy, neoadjuvant endocrine therapy is another option in these usually endocrine-sensitive tumors. The review summarizes the rationale for neoadjuvant treatment in breast cancer and gives an overview of the current standard of care.