This phase II trial tests how well propranolol and pembrolizumab work to cause tumor re-sensitization and therefore treatment in patients with triple negative breast cancer that has not responded to previous checkpoint inhibitor therapy (refractory), cannot be removed by surgery (unresectable) or has spread from where it first started (primary site) to other places in the body (metastatic). Propranolol is a drug that is classified as a beta-blocker. Beta-blockers affect the heart and circulation. Beta-blockers, like propranolol, may help to counteract effects of certain stress hormones produced by the body during cancer treatment and may increase the effectiveness of the pembrolizumab. Pembrolizumab is a drug that is classified as an immune checkpoint inhibitor. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Propranolol may be able to re-sensitize the cells of the immune system to respond to the checkpoint inhibitor pembrolizumab in 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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Undergo tumor biopsy
Undergo blood sample collection
Undergo CT scan
Given IV
Given PO
Ancillary studies
Emory University Hospital
Atlanta, Georgia, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
Objective response
Efficacy as determined by immune-related Response Evaluation Criteria in Solid Tumors (irRECIST). Will be summarized using frequencies and relative frequencies. The best response within the first 6 months will be determined as the best objective response.
Time frame: Up to 6 months
Progression free survival
This will be summarized using standard Kaplan-Meier methods with 90% confidence intervals obtained for the median and 6-month rates.
Time frame: The time treatment initiation until disease progression (per irRECIST), death due to any cause, subsequent therapies (treated as censored), or last follow-up, assessed up to 6 months
Overall survival
Measured per irRECIST. This will be summarized using standard Kaplan-Meier methods with 90% confidence intervals obtained for the median and 6-month rates.
Time frame: The time from treatment initiation until death due to any cause or last follow-up, assessed up to 6 months
Incidence of adverse events of propranolol when given in combination with pembrolizumab
Toxicities and adverse events (as per Common Terminology Criteria for Adverse Events version 5.0) will be summarized by attribution and grade using frequencies and relative frequencies.
Time frame: Up to 2 years
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