The aim of our study was to compare the relative efficacy of Fluorouracil based versus Taxol based regimens, in combination with doxorubicin and cyclophosphamide (FAC Vs TAC) as neoadjuvant chemotherapy for clinically node positive locally advanced breast cancer (LABC). Over a period of two years, 100 women evaluated at a tertiary care center with clinically node positive locally advanced breast cancer were randomized to either receive FAC (500/50/500 mg/m2) every 3 weeks for 3 cycles or TAC (75/50/500 mg/m2) every 3 weeks for 3 cycles. Our primary end point was tumor downsizing after 3 cycles of either regimen. We adjusted data for potential interactions (number of positive nodes, tumor size, and treatment center) and found that tumor downsizing with FAC was very similar to TAC regimen. But more side effects were reported with TAC regimen. There was no toxicity related deaths in either group. Fluorouracil in combination with doxorubicin and cyclophosphamide is equally efficacious in comparison with docetaxel and doxorubicin, cyclophosphamide as neoadjuvant chemotherapy in clinically node positive locally advanced breast cancer. Considering the higher toxicity and cost of TAC as compared to FAC, we recommend FAC as first line regimen for LABC and reserving taxol based therapy for patients with recurrent or resistant breast cancer in developing countries like India.