Dose-Dense Chemotherapy Plus Bevacizumab in High Risk Lymph Node Positive Breast Cancer: A Pilot Study

Inclusion Criteria: * High risk lymph node positive breast cancer defined as 5 or more involved axillary lymph nodes * Must have undergone surgical local therapy (modified radical mastectomy or breast conserving surgery). * Negative tumor margins for invasive cancer * No evidence of distant metastasis * Normal cardiac ejection fraction * Adequate organ function defined as: ANC \> 1200/mm3 Platelet count \> 100,000/mm Serum creatinine \< 2.0 mg/dl Serum bilirubin \< 1.5 x ULN * Performance status 0-1 * Age 18 years or older * No prior chemotherapy, hormonal therapy or radiation therapy for treatment of the primary breast cancer * Bilateral synchronous breast cancer is allowed if other criteria are met. * Patients may be ER/PR+ and receive treatment with hormonal therapy (tamoxifen or aromatase inhibitors) * Use of effective means of contraception (men and women) in subjects of child-bearing potential * Signed informed consent Exclusion Criteria: * Evidence of distant metastases * Inflammatory Breast Cancer * Prior use of any chemotherapy or hormonal therapy for breast cancer * Patients with her 2 neu positive tumors * History of other malignancies within the last 5 years. Prior history of carcinoma in situ of the cervix, melanoma in situ and basal cell carcinoma of the skin is allowed within the last 5 years. * Prior therapy with anthracyclines for any malignancy * Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study other than a Genentech-sponsored bevacizumab cancer study * Blood pressure of equal to or higher than 150/100 * Unstable angina * New York Heart Association (NYHA) Grade II or greater congestive heart failure * History of myocardial infarction within 6 months * History of stroke within 6 months * Clinically significant peripheral vascular disease * Evidence of bleeding diathesis or coagulopathy * Presence of central nervous system or brain metastases * Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 0, anticipation of need for major surgical procedure during the course of the study * Minor surgical procedures such as fine needle aspirations or core biopsies within 7 days prior to Day 0 * Pregnant (positive pregnancy test) or lactating * Urine protein:creatinine ratio \>1.0 at screening * History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to Day 0 * Serious, non-healing wound, ulcer, or bone fracture * Inability to comply with study and/or follow-up procedures