Hormone Therapy and Combination Chemotherapy Before and After Surgery in Treating Patients With Stage I-IIIA Breast Cancer

• Clinical response [ Time Frame: 1 month ] [ Designated as safety issue: No ]
  Defined as a > 50% decrease in sum of the products of the perpendicular diameters of bidimensionally measurable disease.
  
  
• Combined rate of microscopic pathologic complete response and macroscopic pathologic complete response [ Time Frame: Monthly during neoadjuvant CHB and neoadjuvant chemotherapy (XMN) ] [ Designated as safety issue: No ]
  Defined as no evidence of microscopic invasive tumor at the primary site or in the regional lymph nodes at the time of definitive surgical resection and the examining pathologist cannot identify gross residual tumor mass in the surgical specimen.
  
  
• Disease-free survival [ Time Frame: Every 3 months for 3 years, every 6 months for 2 years, and then annually thereafter. ] [ Designated as safety issue: No ]
  
• Overall survival [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  From the start of protocol therapy until the date of death from any cause or the last date the patient was known to be alive.
  
  
• Quantification of all grade 2, 3, 4 or fatal toxicity [ Time Frame: Weekly during CHB, neoadjuvant and adjuvant chemotherapy ] [ Designated as safety issue: Yes ]
  
• Need for dose reduction treatment interruption or treatment discontinuation [ Time Frame: During adjuvant and neoadjuvant chemotherapy ] [ Designated as safety issue: No ]
  

• Correlation of molecular markers with response, time to progression, and survival [ Time Frame: Weekly during CHB and XMN and pacitaxel ] [ Designated as safety issue: No ]
  

PRIMARY OBJECTIVES:

I. To assess the pathologic response rate in patients with operable breast cancer treated with a two part, neoadjuvant regimen consisting of complete hormonal blockade (CHB) for 2 weeks followed by four three-week cycles of Xeloda, Methotrexate and Navelbine with continuation of complete hormonal blockade.

SECONDARY OBJECTIVES:

I. To assess the clinical response rate in patients with surgically resectable breast cancer treated with complete hormonal blockade and four three-week cycles of Xeloda, Methotrexate and Navelbine.

II. To assess the toxicity associated with these regimens. III. To assess the relapse rate, overall and disease-free survival in patients with operable breast cancer when treated with neoadjuvant CHB and XMN + CHB followed by adjuvant treatment using XMN or Taxol.

IV. To assess whether the phenotype of breast cancer changes with treatment. V. To assess whether phenotypic changes in breast tumors predict outcome.

OUTLINE:

NEOADJUVANT CHB: Patients receive exemestane orally (PO) daily for 14 weeks. Premenopausal patients also receive triptorelin pamoate intramuscularly (IM) once monthly for 4 months beginning 2 weeks before the initiation of exemestane.

NEOADJUVANT CHEMOTHERAPY: Patients receive capecitabine PO twice daily (BID) on days 1-14 and methotrexate intravenously (IV) and vinorelbine ditartrate IV over 6-10 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses.

SURGERY: Patients then undergo definitive surgical resection with or without radiation therapy.

ADJUVANT CHEMOTHERAPY: Patients with microscopic complete response (pCR) or disease that has been down-staged to =< 1 cm with no positive nodes receive capecitabine PO BID on days 1-14 and methotrexate IV and vinorelbine ditartrate IV over 6-10 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses. Patients with down-staged T and 0 or 1 positive node receive paclitaxel IV over 1 hour once weekly for 12 weeks.

ADJUVANT HORMONAL THERAPY: Patients receive hormonal therapy for 5 years.

Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 3 years, every 6 months for 2 years, and then annually thereafter.