Bevacizumab With or Without Cyclophosphamide and Methotrexate: A Pilot Study in Women With Operable Breast Cancer

Inclusion Criteria:

* Histologically or cytologically confirmed invasive breast cancer, preoperative stages II-III per AJCC 6th edition, based on baseline evaluation by clinical examination and/or breast imaging
* Patients must have completed preoperative (neoadjuvant) chemotherapy with a standard chemotherapy regimen. No more chemotherapy should be planned.
* Patients must have completed definitive resection of primary tumor with adequate excision of gross disease.
* For patients receiving adjuvant radiation therapy, treatment must be completed prior to initiation of protocol therapy.
* Patients must have the presence of significant residual invasive disease on pathologic review following their preoperative chemotherapy.
* LVEF \> institutional limits of normal after preoperative chemotherapy, as assessed by ECHO or nuclear medicine gated study, within 30 days prior to initiating protocol-based treatment.
* ECOG performance status 0-1

Exclusion Criteria:

* Inadequate organ function, as measured by laboratory assessment after preoperative chemotherapy and within 14 days of beginning protocol-based treatment
* Patients with metastatic disease are ineligible.
* Known HIV infection
* Patients may not be pregnant, expect to become pregnant, plan to conceive a child while on study, or breastfeeding
* Uncontrolled intercurrent illness
* Non-healing wounds or major surgical procedures (such as breast surgery) other than that for venous access device or diagnostic study are not permitted within 28 day prior to enrollment
* History of abdominal fistula, GI perforation, intra-abdominal abscess, or serious, non-healing wound, ulcer, or bone fracture within 6 months prior to initiating bevacizumab
* Patients with any history of arterial thromboembolic events, including transient ischemic attack (TIA), cerebrovascular event (CVA), unstable angina, or myocardial infarction (MI) within the past 6 months. Patients with clinically significant peripheral arterial disease should also be excluded
* History of bleeding diathesis or coagulopathy
* History of grade 3 or 4 allergic reactions to compounds of similar chemical or biologic composition to cyclophosphamide (such as other alkylating agents) or methotrexate (such as other antimetabolites)
* Prior history of malignancy treated without curative intent, excluding nonmelanomatous skin cancer
* Patients with large or rapidly accumulating pleural or abdominal effusions
* Current use of anticoagulants is allowed as long as patients have been on a stable dose for more than two weeks with stable INR
* Chronic therapy with full dose aspirin (\< 325 mg/day) or standard non-steroidal anti-inflammatory agents is allowed
* Patients may not receive other investigational agents while on study