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 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