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Background and objective: To assess how patients with locally advanced breast cancer respond pathologically to neoadjuvant therapy. It is uncommon to have locally advanced breast cancer (LABC), and it poses significant clinical challenges. The purpose of the study was to look into the relationship between disease-free survival and the pathological response to neoadjuvant chemotherapy. Method: An observational study was conducted at Department of General Surgery, Deccan College of Medical Sciences, Hyderabad, Telangana, India from December 2022 to November 2023. on a sample of 40 persons to assess the pathological response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. The study received ethical approval from the committee. Result: Between the ages of 50 and 60, 33% of the population fell. About half of the patients exhibited negative human epidermal growth factor receptor 2 (HER2), positive progesterone receptor (PR), and positive oestrogen receptor (ER). Sixty-seven percent of tumours tested positive for both the progesterone receptor (PR) and the oestrogen receptor (ER). Forty percent of the tumours had HER2 positive results. Merely 17% of the patient cohort exhibited a pathological reaction to neoadjuvant chemotherapy (NACT). 83% of the total did not respond. Conclusion: Finding the cancers that are most likely to respond well to specific medications and treatment strategies might significantly improve the prognosis. The most recent developments in our knowledge of cancer biology and genetic analysis can be used to enhance the therapeutic therapy of locally advanced breast cancer (LABC), producing a very effective individualised strategy. [ABSTRACT FROM AUTHOR]