Propranolol, Pembrolizumab and Chemotherapy for Tumor Re-sensitization and Treatment of Patients with PD-L1 Positive Metastatic or Unresectable Triple Negative Breast Cancer

Inclusion Criteria

• Women age >= 18 years of age
• PD-L1 positive ≥ 10 (by combined positive score [CPS] score) metastatic triple negative breast carcinoma (TNBC)
• Have pathologically confirmed diagnosis of unresectable or metastatic TNBC with no curative treatment options
• Must not have received any other systemic treatment for disease in the metastatic setting
• Have measurable disease per RECIST 1.1 criteria present
• Optional pre-treatment and post treatment biopsies 9 weeks from the start of the study (at least 21 patients in total)
• 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 0-2
• 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 for patients with creatinine levels greater than ULN
• Hemoglobulin (Hb)A1C ≤ 8.5
• 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 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