Doxorubicin Hydrochloride, Cyclophosphamide, and Filgrastim Followed By Paclitaxel Albumin-Stabilized Nanoparticle Formulation With or Without Trastuzumab in Treating Patients With Breast Cancer Previously Treated With Surgery
Condition: Estrogen Receptor-positive Breast Cancer; HER2-positive Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer
MeSH terms: Breast Neoplasms
Intervention: doxorubicin hydrochloride; cyclophosphamide; filgrastim; paclitaxel albumin-stabilized nanoparticle formulation; trastuzumab; laboratory biomarker analysis; quality-of-life assessment
Intervention description: Given IV; Given orally; Given SC; Given IV; Given IV; Correlative studies; Ancillary studies
Intervention MeSH terms: Paclitaxel; Albumin-Bound Paclitaxel; Cyclophosphamide; Doxorubicin; Liposomal doxorubicin; Trastuzumab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 60.0
Sex: Female
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      RATIONALE: Drugs used in chemotherapy, such as doxorubicin hydrochloride, cyclophosphamide,
      and paclitaxel albumin-stabilized nanoparticle formulation, work in different ways to stop
      the growth of tumor cells, either by killing the cells or by stopping them from dividing.
      Colony-stimulating factors, such as filgrastim, may increase the number of immune cells found
      in bone marrow or peripheral blood and may help the immune system recover from the side
      effects of chemotherapy. Monoclonal antibodies, such as trastuzumab, can block tumor growth
      in different ways. Some block the ability of tumor cells to grow and spread. Others find
      tumor cells and help kill them or carry tumor-killing substances to them. Giving combination
      chemotherapy and filgrastim together with trastuzumab may kill more tumor cells.

      PURPOSE: This phase II trial is studying how well giving doxorubicin hydrochloride,
      cyclophosphamide, and filgrastim together followed by paclitaxel albumin-stabilized
      nanoparticle formulation and trastuzumab works in treating patients with breast cancer
      previously treated with surgery
    

Eligibility criteria:

        Inclusion Criteria:

          -  Have a histologically confirmed diagnosis of primary breast carcinoma that has been
             surgically resected; (this regimen is not intended for neoadjuvant treatment)

          -  4 + nodes

          -  OR if 1-3 + nodes, either ER OR HER-2/neu+

          -  OR have high-risk node negative disease that is HER-2/neu positive OR >= 2.0 cm tumor
             size

          -  HER-2/new + definition: patient has known tumor HER-2/new expression = 3+ by IHC or,
             if 2+ by IHC confirmed to be FISH positive

          -  Patients with clinically apparent cardiac disease, or history of same, are not
             eligible; patients who are >= 60 years of age or who have a history of hypertension
             must have an echocardiogram or MUGA prior to enrollment; patients with breast cancer
             that is HER-2/neu positive and a treatment plan that includes Herceptin must have an
             echocardiogram or MUGA scan prior to enrollment; the LVEF must be within the
             institutional normal range; if LVEF is > 75%, the investigator should consider having
             the LVEF reviewed or repeating the MUGA prior to registration

          -  WBC >= 4,000

          -  ANC >= 1,500

          -  Platelet count >= 100,000

          -  Serum creatinine =< 1.5 x IULN

          -  Bilirubin =< 2.0

          -  SGOT/SGPT/alkaline phosphatase =< 2 x IULN

          -  Elevations greater than these require metastatic work up

          -  Be informed of the investigational nature of this study and provide written informed
             consent in accordance with institutional and federal guidelines prior to study
             specific screening procedures

        Exclusion Criteria:

          -  Except for the following, no other malignancy is allowed: synchronous ipsilateral
             breast cancer of the same subtype (ER/PR, HER-2/neu), adequately treated basal cell or
             squamous cell skin cancer, in situcervical cancer or other stage I or II cancer from
             which the patient has been disease free for at least 5 years

          -  Patients with cardiac disease that would preclude the use of Adriamycin, Taxol or
             Herceptin are not eligible; this includes:

          -  Angina pectoris that requires the use of antianginal medication

          -  Cardiac arrhythmia requiring medication

          -  Severe conduction abnormality

          -  Clinically significant valvular disease

          -  Cardiomegaly on chest x-ray

          -  Ventricular hypertrophy on EKG

          -  Uncontrolled hypertension, (diastolic greater than 100 mm/Hg or systolic > 200 mm/hg)

          -  Current use of digitalis or beta blockers for CHF

          -  Clinically significant pericardial effusion

          -  Myocardial infarction documented as a clinical diagnosis or by EKG or any other test

          -  Documented congestive heart failure

          -  Documented cardiomyopathy

          -  Documented arrhythmia or cardiac valvular disease that requires medication or is
             medically significant

          -  Patients who have received prior chemotherapy or radiotherapy are not eligible

          -  Patients who are pregnant or breastfeeding are not eligible; women of child bearing
             potential must agree to practice adequate contraception

          -  Patients with active infection are not eligible

          -  Patients who are known to be infected with HIV, hepatitis B or hepatitis C are not
             eligible; testing is not required unless there is a high index of clinical suspicion

          -  Patients suffering from psychiatric impairment are not eligible