Breast cancer remains a major cause of cancer-related morbidity and mortality among women, and locally advanced disease continues to pose significant therapeutic challenges. Neoadjuvant chemotherapy is commonly administered to reduce tumor burden and improve surgical operability, with anthracycline- and taxane-based regimens being widely used. This study aimed to compare the effectiveness and adverse effects of anthracycline-based and taxane-based neoadjuvant chemotherapy in patients with locally advanced breast cancer at Prof. Dr. R. D. Kandou General Hospital. An observational analytic study with a prospective cohort design was conducted involving 27 female patients, comprising 11 patients who received anthracycline-based chemotherapy and 16 patients who received taxane-based chemotherapy. Tumor response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, while adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE). The results showed that partial response was the predominant outcome in both groups, occurring in 81.82% of patients in the anthracycline group and 75% of patients in the taxane group. The Mann–Whitney test revealed no significant difference in treatment effectiveness between the two regimens (p = 0.708). Most adverse effects were mild to moderate, although toxicity patterns differed between the groups. In conclusion, both regimens demonstrated comparable effectiveness, while treatment selection should consider patient characteristics, organ function, tolerability, and regimen-specific adverse-effect risks. These findings support individualized regimen selection based on therapeutic efficacy and anticipated toxicity profiles.