Currently, human epidermal growth factor receptor 2 (HER-2) positive breast cancer has become a focus and hotspot in the research of breast cancer treatment due to its unique target and therapeutic drugs. Early treatment is particularly important for diagnosed breast cancer. Breast cancer treatment is mainly divided into two categories: local treatment, including early breast-conserving surgery, sentinel lymph nodes, and regional lymph node radiotherapy, and systemic treatment, including neoadjuvant therapy and adjuvant therapy. Although surgical treatment is currently the main treatment for breast cancer, some patients require neoadjuvant therapy before surgery. The population receiving neoadjuvant therapy mostly consists of stage Ⅲ breast cancer or some stage IIA and IIB patients, highlighting the importance of neoadjuvant therapy. In light of these two points, neoadjuvant therapy for HER-2 positive breast cancer needs special attention. Currently, four hot topics in this area require further exploration: 1. The treatment of breast cancer with anthracycline drugs, which has sparked controversy among researchers due to its cornerstone role in neoadjuvant therapy for breast cancer and its cardiotoxic side effects. Whether it exacerbates the condition and affects surgical standards for patients with underlying diseases, especially heart-related issues, is a concern. 2. The selection of the neoadjuvant targeted therapy cycle. The choice of treatment duration is equally important. A short treatment period may not meet the surgical standards, while a long treatment duration may cause patients to miss the optimal surgical timing, delaying their condition. The patient's tolerance to extended treatment and their psychological state also impact the success of the surgery. 3. The selection of the optimal combination targeted therapy based on trastuzumab. Single-target therapy was strongly recommended by experts in the early stages of HER-2 positive breast cancer research. However, with the approval of more drugs in China, the use of dual-target drugs for treating HER-2 positive breast cancer has become a hot topic within the field. 4. The choice of dual-target therapy after neoadjuvant therapy for HER-2 positive breast cancer. The selection of dual-target therapy after neoadjuvant therapy depends on the patient's sensitivity to the drugs during neoadjuvant treatment and whether they achieve the patient's desired pathological complete response rate (pCR). The following discussion will delve into these four hot topics, providing new insights for clinical practice.