Combination Chemotherapy With or Without Colony-stimulating Factors in Treating Women With Breast Cancer

DISEASE CHARACTERISTICS:

Histologically confirmed adenocarcinoma of the breast that is potentially curable

T0-4 (dermal involvement on pathology assessment only), N0-2, M0
No clinical T4 disease

Previously treated with one of the following:

Total mastectomy and level II axillary node dissection
Partial mastectomy and level II axillary node dissection with planned breast radiotherapy after completion of adjuvant chemotherapy regimen*
Patients with a positive sentinel node biopsy must undergo level II axillary node dissection or sufficient nodal sampling
If microscopic residual in situ or invasive disease is present at total or partial mastectomy margins, planned radiotherapy must also include a boost to the tumor bed
No residual tumor in the axilla after dissection

Axillary node positive

Negative nodes allowed if the tumor is ≥ 1 cm and 1 or more of the following criteria defining high-risk node-negative disease are met:

Histological grade III or,
Estrogen receptor negative or,
Lymphatic/vascular invasion

Hormone receptor status:

Estrogen receptor status known

PATIENT CHARACTERISTICS:

Age:

60 and under

Sex:

Female

Menopausal status:

Pre- or postmenopausal

Performance status:

ECOG 0-2

Life expectancy:

At least 5 years

Hematopoietic:

WBC ≥ 3,000/mm^3
Platelet count ≥ 100,000/mm^3

Hepatic:

Bilirubin ≤ 1.5 times upper limit of normal (ULN)

Renal:

Creatinine ≤ 1.5 times ULN

Cardiovascular:

LVEF ≥ limit of normal by MUGA or echocardiogram
No arrhythmia requiring ongoing treatment
No congestive heart failure
No documented coronary artery disease

Other:

No other malignancy except:

Adequately treated basal cell or squamous cell skin cancer or carcinoma in situ of the cervix
Ductal or lobular carcinoma in situ that has been curatively treated by surgery alone
Other prior malignancies (except breast cancer) curatively treated more than 5 years prior to study entry
No serious underlying medical illness or psychiatric or addictive disorder that would preclude study compliance
No known hypersensitivity to E. coli-derived products, mammalian-cell derived products, or any study agents
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective non-hormonal contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

No prior immunotherapy for breast cancer

No concurrent pegfilgrastim or darbepoetin alfa (Arm II)

Allowed on arms 1 and 3 if medically necessary

Chemotherapy:

No prior chemotherapy for breast cancer

Endocrine therapy:

No prior hormonal therapy for breast cancer
No concurrent hormone replacement therapy
No concurrent selective estrogen-receptor modulators (e.g., raloxifene for the treatment or prevention of osteoporosis)
No concurrent oral contraceptives (i.e., birth control pills)
No other concurrent aromatase inhibitors

Radiotherapy:

See Disease Characteristics
No prior radiotherapy for breast cancer

Surgery:

See Disease Characteristics
No more than 12 weeks since prior total or partial mastectomy (including re-excision of margins)

Other:

At least 30 days since prior investigational drugs
No other concurrent investigational drugs
Concurrent bisphosphonates for the treatment or prevention of osteoporosis allowed