Axitinib and Avelumab in Treating Patients With Recurrent or Metastatic Adenoid Cystic Carcinoma

Exclusion Criteria

• •Current use of immunosuppressive medication, EXCEPT for the following:
• •* Intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection)
• •* Systemic corticosteroids at physiologic doses =\< 10 mg/day of prednisone or equivalent
• •* Steroids as premedication for hypersensitivity reactions (e.g., computed tomography \[CT\] scan premedication)
• •Active autoimmune disease that might deteriorate when receiving an immuno-stimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment are eligible
• •Prior organ transplantation including allogenic stem-cell transplantation
• •Active infection requiring systemic therapy
• •Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome
• •Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening (positive HBV surface antigen or HCV ribonucleic acid \[RNA\] if anti-HCV antibody screening test positive)
• •Vaccination within 4 weeks of the first dose of avelumab and while on trials is prohibited except for administration of inactivated vaccines
• •Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (National Cancer Institute \[NCI\] Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\]4.03 grade \>= 3)
• •Clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke (\< 6 months prior to enrollment), myocardial infarction (\< 6 months prior to enrollment), unstable angina, congestive heart failure (\>= New York Heart Association Classification class II), or serious cardiac arrhythmia requiring medication
• •Persisting toxicity related to prior therapy (NCI CTCAE v. 4.03 grade \> 1); however, alopecia, sensory neuropathy grade =\< 2, or other grade =\< 2 not constituting a safety risk based on investigator's judgment are acceptable
• •Inadequately controlled hypertension (defined as systolic blood pressure \> 140 mmHg and/or diastolic blood pressure \> 90 mmHg). Anti-hypertensive therapy to maintain a systolic blood pressure \< 140 mmHg and/or diastolic blood pressure \< 90 mmHg is permitted
• •Prior history of hypertensive crisis or hypertensive encephalopathy
• •Patients with a baseline electrocardiography (EKG) demonstrating a QTc \> 470 ms
• •Serious non-healing or dehiscing wound, active ulcer or untreated bone fracture
• •Proteinuria as demonstrated by urine dipstick or \> 1 g of protein in a 24 hour urine collection. All patients with \>= 2+ protein on dipstick urinalysis at baseline must undergo a 24 hour urine collection for protein
• •Evidence of bleeding diathesis or clinically significant coagulopathy (in the absence of therapeutic anticoagulation)
• •Other severe acute or chronic medical conditions including immune colitis, inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study
• •Subject with an uncontrolled seizure disorder, active neurologic disease, or active central nervous system (CNS) involvement except for individuals who have previously-treated CNS metastases, are asymptomatic, and have no requirement for doses of corticosteroids (indicated to reduce brain edema) higher than the equivalent of 10 mg of oral prednisone a day or anti-seizure medication for at least 2 weeks prior to first dose of study drug
• •History of ongoing malignancies or malignancies in remission \< 2 years. Adequately curative intent treated initial stage non-melanoma skin cancers; in situ carcinoma of the cervix; breast carcinoma in situ; low-grade local bladder cancer; and low-risk prostate cancer undergoing active surveillance will be allowed
• •Pregnant women are excluded from this study. Based on its mechanism of action. Avelumab can cause fetal harm when administered to a pregnant woman. In animal models, the PD-1/PD-L1 signaling pathway is important in the maintenance of pregnancy through induction of maternal immune tolerance to fetal tissue. Human IgG1 immunoglobulins are known to cross the placenta. Therefore, avelumab has the potential to be transmitted from the mother to the developing fetus. Blockade of PD-L1 signaling has been shown in murine models of pregnancy to disrupt tolerance to the fetus and to result in an increase in fetal loss. Therefore, potential risks of administering avelumab during pregnancy include increased rates of abortion or stillbirth. Advise females of reproductive potential to use effective contraception during treatment with avelumab and for at least one month after the last dose of avelumab
• •Lactating females: There is no information regarding the presence of avelumab in human milk, the effects on the breastfed infant, or the effects on milk production. Since many drugs including antibodies are excreted in human milk, advise a lactating woman not to breastfeed during treatment and for at least one month after the last dose of avelumab due to the potential for serious adverse reactions in breastfed infants
• •Prior treatment with immune checkpoint inhibitor (e.g. anti-PD-1/PD-L1)
• •Prior treatment with VEGF or VEGFR inhibitors (e.g. lenvatinib, bevacizumab)