Inclusion Criteria:

- Diagnosis of locally advanced breast cancer

- T > 2 cm (any N), or any T and positive node(needle biopsy is required if tumor size
is less than 2cm)

- Non-metastatic disease confirmed by computerized tomography and bone scan

- HER2 positive by IHC (+++) and/or Fish (+) according to international definitions
(ASCO 2007)

- Normal left ventricular ejection fraction (LVEF)

- Indication of preoperative chemotherapy

- multifocal tumors acceptable provided that the largest tumor is Her2-positive

- ECOG 0-1

Exclusion Criteria:

- Another malignancy within the last 5 years (except curatively treated skin carcinoma,
in situ cervix carcinoma, in situ ductal carcinoma of the breast, or in situ lobular
carcinoma of the breast)

- Clinically significant comorbidities such as cardiovascular diseases, COPD, renal or
liver impairment, psychiatric disorders

- LVEF value below institutional limits of normal range

- Detected or suspected distant metastasis

- Neutrophils lower than 1,500/µL, platelets lower than 100,000/µL, hemoglobin lower
than 10 g/dL, AST higher than 2.5x upper limit of normal (ULN), total bilirubin
higher than ULN, alkaline phosphatase more than 1.5x ULN