Patient description: The patient is a 45-year-old postmenopausal woman with cytologically confirmed breast cancer. A core biopsy revealed a 3 cm invasive ductal breast carcinoma in the left upper outer quadrant. The tumor is HER2-positive and ER/PR negative. Axillary sampling revealed 5 positive lymph nodes. CXR was remarkable for metastatic lesions. The patient is using multivitamins and iron supplements. She does not smoke or consume alcohol. She is not sexually active and has no children. She is a candidate for tumor resection and agrees to do so prior to chemotherapy.

Clinical trial eligibility criteria: eligible ages (years): 19.0-999.0,  Breast Cancer Female patients who are >18 years of age 2. ECOG 0 or 1 3. The tumor must be invasive carcinoma of the breast on histologic examination 4. The tumor must have been determined to be HER2-negative, as follows IHC 0 or 1+; or IHC 2+ and ISH non-amplified, with a ratio of <2.0, and if reported, an average HER2 gene copy number of <6 signals/cell; or ISH non-amplified without IHC 5. The tumor must have been determined to be ER and PR-negative, as assessed by the current ASCO/CAP guidelines. 6. All of the following staging (AJCC 7th edition) must be met Lymph node-positive disease: cytologically positive in the neoadjuvant group* and pathologically positive in the adjuvant group If the lymph node is cytologically or pathologically negative, the tumor size must be >2.0 cm (* In the neoadjuvant group, if there is evidence of suspicious axillary lymph nodes at the baseline imaging study or physical examination, then FNA or core biopsy is required to confirm the nodal status) 7. The patient must have undergone either a mastectomy or lumpectomy in the adjuvant group 8. The patient must have completed one of the nodal surgery procedures listed below in the adjuvant group Sentinel lymph node biopsy (SLNB) alone: V If pathologic nodal staging based on SLNB is pN0 V If pathologic nodal staging based on SLNB is 1 or 2 positive nodes, the primary tumor must be T1 or T2 by pathologic evaluation and lumpectomy and the nodal involvement must be limited to 1 or 2 positive nodes SLNB followed by removal of additional non-sentinel LNs if the SLN is positive; or Axillary lymphadenectomy with or without SLNB (In the neoadjuvant group, if baseline LN NAB or core biopsy is positive, ALND should be performed) 9) LVEF assessment by echocardiography or MUGA scan must be >50%, regardless of the cardiac imaging facility's lower limit of normal 10) The patient must have adequate hepatic, renal, and bone marrow function  Any prior systemic treatment for primary invasive breast cancer 2. cT4 or pT4 tumors including inflammatory breast cancer 3. Occult breast cancer 4. Evidence of metastatic breast cancer 5. Patients with second primary cancer; adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, DCIS of the breast, thyroid cancer with a size of <2 cm (papillary, follicular, and medullary type), and other solid tumors curatively treated with no evidence of disease for >5 years prior to randomization. 6. Simultaneous bilateral breast cancer 7. Patients considered a poor medical risk due to a serious, uncontrolled medical disorder or uncontrolled infection. 8. Pregnant or breastfeeding women