Propranolol and Pembrolizumab for Tumor Re-sensitization and Treatment of Patients With Checkpoint Inhibitor Refractory Metastatic or Unresectable Triple Negative Breast Cancer

PRIMARY OBJECTIVE: I. Determine the efficacy of propranolol on tumor re-sensitization, when given in combination with pembrolizumab in patients with checkpoint inhibitor refractory metastatic triple negative breast cancer. SECONDARY OBJECTIVES: I. Assess 6-month progression-free and overall survival per immune-related Response Evaluation Criteria in Solid Tumors (irRECIST). II. Safety and tolerability of propranolol when given in combination with pembrolizumab. EXPLORATORY OBJECTIVES: I. Assess changes in immune markers (pre-treatment versus \[vs\] post-treatment) in biopsy and peripheral blood. II. Correlate perceived stress scale with immune exhaustion markers and immune cells in the peripheral blood and tumor. OUTLINE: Patients receive propranolol orally (PO) and pembrolizumab intravenously (IV) while on study. Patients undergo computed tomography (CT) scan, blood sample collection and may undergo tumor biopsy during screening and on study.

Age

18–any

Sex

FEMALE

Healthy volunteers

Not accepted

You may be eligible if

Age \>= 18 years of age
Have pathologically confirmed diagnosis of unresectable or metastatic triple negative breast cancer (TNBC) with no curative treatment options
No chemotherapy, radiotherapy, or major surgery within 4 weeks of protocol treatment
Checkpoint inhibitor refractory patients (i.e., no longer responding to chemotherapy and checkpoint inhibitor) who have disease progression on prior line of chemotherapy and pembrolizumab, and, who in the opinion of the physician, can continue checkpoint inhibitor
Patients must be agreeable to pre- and 6-week post treatment biopsy in part 1 of the study
* The pre-treatment biopsy for this study must be taken at least 4 weeks after all previous chemotherapy (pembrolizumab is allowed during this period)
Participants of child-bearing potential must agree to use adequate contraceptive methods (e.g. hormonal or barrier method of birth control; abstinence) prior to study entry. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
Have an Eastern Cooperative Oncology Group (ECOG) Performance Status of =\< 1
Platelets \>= 100,000/uL
Hemoglobin \>= 9.0 g/dL
Absolute neutrophil count (ANC) \>= 1500/uL
Total bilirubin =\< institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) =\< 2.5 X institutional ULN
Creatinine clearance \>= 50 mL/min per Cockcroft-Gault equation
HbA1C \<=8.5
Have measurable disease per RECIST 1.1 criteria present
Ability to swallow and retain oral medication
Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure

You may not be if

Patients currently treated with systemic immunosuppressive agents, including steroids, are ineligible until 3 weeks after removal from immunosuppressive treatment
Patients with active autoimmune disease, requiring ongoing immunosuppressive therapy or history of transplantation
Patients with rapidly progressive disease/ symptomatic disease
Patients with primary resistance (i.e., did not respond to initial treatment with chemotherapy plus checkpoint inhibitor) with progressive disease at 12 weeks after starting chemotherapy and pembrolizumab
Patients who are pregnant or nursing. Women of childbearing potential (WOCBP) will have to undergo a urine pregnancy test as part of screening
Participants with symptomatic known brain metastases \< 4 weeks from radiation treatment should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events
History of malignancy other than breast cancer within 5 years prior to screening, with the exception of those with a negligible risk of metastases or death
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Unwilling or unable to follow protocol requirements
Contraindications to the use of beta-blockers, like: uncontrolled depression, unstable angina pectoris, uncontrolled heart failure (grade III or IV), hypotension (systolic blood pressure \< 100 mmHg), severe asthma or chronic obstructive pulmonary disease (COPD), uncontrolled type I or type II diabetes mellitus (hemoglobin A1C \[HbA1C\] \> 8.5 or fasting plasma glucose \> 160 mg/dl at screening), symptomatic peripheral arterial disease or Raynaud's syndrome, untreated pheochromocytoma, current use of beta-blockers or non-dihydropyridine calcium channel blockers
Any additional condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs

What this study is about