Background: The prevalence of locally advanced breast cancer is increasing yearly, so biomarkers are needed to assist in its management, one of which is tumour necrosis factor-alpha (TNF-α). Objective: Analysing TNF-α levels as a predictor factor on clinical response anthracycline-based neoadjuvant chemotherapy. Methods: This study design used observational analysis. The length of study was carried out in the period from May 2021 to June 2022. The study procedure included measuring participants' TNF-α levels the day before chemotherapy was carried out and clinical response. Participants received anthracycline-based neoadjuvant chemotherapy (cyclophosphamide of 500 mg/m 2 , doxorubicin of 50 mg/m 2 and fluorouracil/5FU of 500 mg/m 2 ) for 3 cycles. The study analysis used the Chi-square, logistic regression and Spearman’s test with P <0.05. Results: The average TNF-α levels was 137.2±311.8 pg/ml, ranging from 5.74 to 1.733 pg/ml. The results of the calculation of the cutoff value of TNF-α in the study were 18 635 pg/ml (area under curve =0.850; 95% CI =0.729–0.971). Based on cutoff 1, most participants with high TNF-α levels also had a negative response of 83.3% and those with low TNF-α levels also had a positive response of 75% ( P <0.001). Meanwhile, at cutoff 2, similar conditions were also found, namely high TNF-α levels, negative response (84.2%) and low TNF-α levels, positive response (78.9%; P <0.001). The statical analysis showed a significant association of TNF-α levels on the clinical response of chemotherapy, which showed r =−0.606 and P <0.001. Conclusion: TNF-α levels predict clinical response for anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer patients.