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

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 p