Combination Chemotherapy in Treating Women With Stage I, Stage II, or Stage IIIA (cT1-3, N0-1, M0) Breast Cancer and Positive Axillary Lymph Nodes

You may be eligible if

• DISEASE CHARACTERISTICS:
• Histologically confirmed invasive adenocarcinoma of the breast
• * Confined to the breast and ipsilateral axilla on clinical exam
• * Stage I, II, or IIIA (cT1-3, N0-1, M0)
• At least one axillary lymph node with evidence of tumor on histologic exam
• * Sentinel node biopsy allowed if followed by axillary dissection
• * No suspicious palpable nodes in the contralateral axilla or palpable supraclavicular or infraclavicular nodes, unless proven on biopsy to not be involved with tumor
• No bilateral malignancy or mass in the opposite breast, unless mass is histologically proven to be benign
• Must have undergone either a prior total mastectomy and axillary dissection (modified radical mastectomy) OR
• Prior lumpectomy and axillary dissection
• * Patients must receive radiotherapy after randomization (not before) AND after chemotherapy
• * Margins must be clear
• * No ipsilateral lymph nodes that are fixed to one another or to other structures (N2 disease) and/or any positive nonaxillary lymph nodes (intramammary nodes are considered axillary nodes)
• * No histologically evident invasive tumor or ductal carcinoma in situ
• * No diffuse tumors by mammography that would not be surgically amenable to lumpectomy
• * No other dominant mass in the ipsilateral breast remnant unless one of the following is true:
• * Histologically benign
• * Surgically removed with clear margins if malignant
• No ulceration, erythema, infiltration of the skin or underlying chest wall (complete fixation), peau d'orange, or skin edema of any magnitude
• * Tethering or dimpling of the skin or nipple inversion allowed
• No metastatic disease
• * Skeletal pain allowed if bone scan negative for metastases
• Hormone receptor status:
• * Estrogen and progesterone status determined
• PATIENT CHARACTERISTICS:
• Age:
• greater than or equal to 18 years
• Sex:
• Female
• Menopausal status:
• Not specified
• Performance status:
• Not specified
• Life expectancy:
• At least 10 years, excluding diagnosis of cancer
• Hematopoietic:
• Absolute neutrophil count at least 1,500/mm\^3 (may be less, if in the opinion of the investigator, this represents an ethnic or racial variation)
• Platelet count at least 100,000/mm\^3\* NOTE: \*If platelet count is above the upper limit of normal (ULN), significant underlying hematologic disorders must be excluded
• Hepatic:
• Bilirubin no greater than ULN
• Alkaline phosphatase less than 2.5 times ULN\*
• SGOT less than 1.5 times ULN\*
• No nonmalignant systemic hepatic disease that would preclude study participation NOTE: \*Alkaline phosphatase and SGOT cannot both be greater than ULN
• Renal:
• Creatinine no greater than normal
• No nonmalignant systemic renal disease that would preclude study participation
• Cardiovascular:
• No nonmalignant systemic cardiovascular disease that would preclude study participation
• LVEF at least lower limit of normal (LLN) by MUGA or echocardiogram
• No active cardiac disease that would preclude use of doxorubicin or docetaxel, including the following:
• * Any prior myocardial infarction
• * Angina pectoris requiring anti-anginal medication
• * History of congestive heart failure
• * Cardiac arrhythmia requiring medication
• * Severe conduction abnormality
• * Valvular disease with documented cardiac function compromise
• * Cardiomegaly on chest x-ray or ventricular hypertrophy on EKG, unless LVEF at least LLN
• * Poorly controlled hypertension (diastolic greater than 100 mm/Hg)
• * Hypertension well controlled by medication allowed
• Other:
• No grade 2 or greater peripheral neuropathy
• No other prior malignancy within the past 5 years except:
• * Effectively treated squamous cell or basal cell skin cancer
• * Surgically treated carcinoma in situ of the cervix
• * Segmentally resected lobular carcinoma in situ of the ipsilateral or contralateral breast
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective barrier contraception
• No nonmalignant systemic disease that would preclude study participation
• No diabetes with morning fasting blood glucose of 200 mg/dL or greater
• No psychiatric or addictive disorders that would preclude informed consent
• No contraindication to corticosteroids that would preclude study participation
• PRIOR CONCURRENT THERAPY:
• Biologic therapy:
• No prior immunotherapy for breast cancer
• Chemotherapy:
• No prior chemotherapy for breast cancer
• No prior anthracyclines or taxanes
• No other concurrent investigational chemotherapy
• Endocrine therapy:
• No prior hormonal therapy for breast cancer
• No concurrent hormonal birth control methods or other hormonal therapy
• No concurrent raloxifene, including for osteoporosis
• Concurrent low-dose topical estrogen in the form of conjugated estrogen ring or conjugated estrogen vaginal cream (dose no more than 0.3 mg or 1/8 of an applicator applied vaginally 3 times a week) allowed
• Radiotherapy:
• See Disease Characteristics
• No prior radiotherapy for this malignancy
• Surgery:
• See Disease Characteristics
• No more than 84 days since prior surgery for breast cancer (e.g., lumpectomy, mastectomy, sentinel node biopsy, axillary dissection, or re-excision of lumpectomy margins)
• Other:
• No prior systemic therapy for this malignancy
• No concurrent medications that alter cardiac conduction (e.g., digitalis, beta blockers, or calcium-channel blockers) for cardiac arrhythmia, angina, or congestive heart failure (allowed if administered for other reasons \[e.g., hypertension\])
• Concurrent bisphosphonates allowed