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

Launched by ROSWELL PARK CANCER INSTITUTE · Feb 14, 2023

Keywords

ClinConnect Summary

This clinical trial is studying the combination of two medications, propranolol and pembrolizumab, to see if they can help treat women with a type of breast cancer called triple-negative breast cancer (TNBC) that hasn't responded to other treatments. Triple-negative breast cancer is particularly challenging because it does not have specific targets for treatment, and this study focuses on patients whose cancer has either spread to other parts of the body or cannot be removed with surgery. Propranolol is a medication that typically helps with heart issues and may also help improve the effectiveness of pembrolizumab, which boosts the immune system to fight cancer.

To be eligible for this trial, participants need to be at least 18 years old and have a confirmed diagnosis of unresectable or metastatic TNBC with no available curative treatments. They should have experienced disease progression after previous chemotherapy and checkpoint inhibitor therapy. Participants will undergo a biopsy before starting the treatment and again six weeks later to assess how well the treatment is working. It's important for potential participants to understand the study's purpose and provide informed consent before joining. Overall, this trial aims to find new ways to help women with difficult-to-treat breast cancer, and participants will be closely monitored throughout the study.

Gender

FEMALE

Eligibility criteria

• Inclusion Criteria:
• • 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
• Exclusion Criteria:
• • 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