cryoablation, atezolizumab/nab-paclitaxel for locally advanced or metastatic triple negative breast cancer

Conditions: Anatomic Stage III Breast Cancer AJCC v8; Anatomic Stage IIIA Breast Cancer AJCC v8; Anatomic Stage IIIB Breast Cancer AJCC v8; Anatomic Stage IIIC Breast Cancer AJCC v8; Anatomic Stage IV Breast Cancer AJCC v8; Locally Advanced Breast Carcinoma; Metastatic Triple-Negative Breast Carcinoma; Prognostic Stage III Breast Cancer AJCC v8; Prognostic Stage IIIA Breast Cancer AJCC v8; Prognostic Stage IIIB Breast Cancer AJCC v8; Prognostic Stage IIIC Breast Cancer AJCC v8; Prognostic Stage IV Breast Cancer AJCC v8

Summary: this early phase i trial studies the side effects and feasibility of cryoablation, atezolizumab, and nab-paclitaxel in treating patients with triple negative breast cancer that has spread to nearby tissue or lymph nodes (locally advanced) or has spread to other places in the body (metastatic). cryosurgery, also known as cryoablation or cryotherapy, kills tumor cells by freezing them. immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. drugs used in chemotherapy, such as nab-paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. giving cryoablation, atezolizumab and nab-paclitaxel may improve response to the disease.

primary objective: i. to determine the safety and feasibility of cryoablation of a primary breast tumor followed by pd-l1 blockade in patients with locally advanced or metastatic triple negative breast cancer (tnbc). scondary objective: i. to evaluate the systemic immune response to cryoablation of a primary breast tumor and pd-l1 blockade. outline: patients undergo cryoablation of the primary tumor over about 1 hour. after 2-3 weeks, patients receive atezolizumab intravenously (iv) on days 1 and 15 and nab-paclitaxel iv on days 1, 8, and 15. cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. after completion of study treatment, patients are followed up at 2-3 weeks post surgery and then periodically thereafter.

Eligibility criteria:
inclusion criteria: * locally advanced or metastatic pd-l1 positive tnbc (tnbc is defined as estrogen receptor \[er\] \ = 1%.) * presents with primary breast tumor lesion amenable to cryoablation * have at least one additional distant lesion feasible for biopsies * agreeable to start on atezolizumab and nab-paclitaxel as per standard of care * patients with locally advanced disease must be ineligible for curative surgery for any reason, including but not limited to comorbid status precluding surgery due to safety, unresectability, or patient refusal * patient may have received prior systemic chemotherapy regimens exclusion criteria: * history of autoimmune disease * history of human immunodeficiency virus (hiv) * previous immune checkpoint targeting therapies * no primary breast lesion amenable for cryoablation due to size (greater than 5 cm) or location (proximity of \< 0.5 cm to the skin or nipple-areola complex) * pregnancy