Pegylated Liposomal Doxorubicin Hydrochloride With Atezolizumab and/or Bevacizumab in Treating Patients With Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Inclusion Criteria:

• Patients must have the psychological ability and general health that permitscompletion of the study requirements and required follow up

• Administration of study drugs (pegylated liposomal doxorubicin, bevacizumab,atezolizumab) may have an adverse effect on pregnancy and poses a risk to the humanfetus, including embryo-lethality; women of child-bearing potential (WOCBP) mustagree to use adequate contraception (hormonal or barrier method of birth control;abstinence) prior to study entry, for the duration of study participation, and for 5months (150 days) after the last dose of study agent; should a woman become pregnantor suspect she is pregnant while she is participating in this study, she shouldinform her treating physician immediately. (06/29/2017)

• Submission of tumor tissue is required for all patients; investigators should checkwith their site pathology department regarding release of biospecimens beforeapproaching patients about participation in the trial

• High grade ovarian cancer, including high grade serous; clear cell; endometrioid,grade 3; and others (adenocarcinoma, not otherwise specified [NOS]; mixed epithelialcarcinoma; undifferentiated carcinoma); NOTE: low grade serous, mucinous andcarcinosarcoma histologies are excluded due to their different underlying genomicfeatures and/or clinical behavior; ovarian cancer = ovarian, fallopian tube orprimary peritoneal cancer; required data element: submission of pathology report

• Recurrent, platinum resistant ovarian cancer (defined as progression within < 6months from completion of platinum based therapy; the date should be calculated fromthe last administered dose of platinum therapy)

• 1-2 prior regimens (including primary therapy); hormonal therapies (e.g., tamoxifen,aromatase inhibitors) will not count toward the prior regimen limit; PARP inhibitorsgiven in the maintenance setting post response to platinum-based therapy will notcount as a separate regimen from the preceding platinum-based therapy. (30-OCT-2020)

• Measurable disease (defined by RECIST v1.1) or evaluable disease (defined as solidand/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1definitions for target lesions OR ascites and/or pleural effusion that has beenpathologically demonstrated to be disease related in the setting of cancer antigen [CA] 125 >= 2 x upper limit of normal [ULN])

• Age >= 18

• Performance status 0, 1 or 2

• Absolute neutrophil count (ANC) >= 1,500/mcl (within 14 days prior to registration)

• Platelets >= 100,000/mcl (within 14 days prior to registration)

• Hemoglobin (Hgb) >= 8 g/dl (within 14 days prior to registration)

• Creatinine =< 1.5 x institutional upper limit of normal (ULN) (within 14 days priorto registration)

• Urine protein creatinine (UPC) ratio must be < 1.0 (within 14 days prior toregistration); if UPC ratio >= 1, collection of 24-hour urine measurement of urineprotein is recommended (24-hour urine protein level must be < 1000 mg for patientenrollment); If UPC ratio cannot be calculated because the urine protein is belowthe lower limit of detection of the assay this will not exclude the patient (10/22/2018) (30-OCT-2020); UPC ratio of spot urine is an estimation of the 24-hoururine protein excretion - a UPC ratio of 1 is roughly equivalent to a 24-hour urineprotein of 1 gm

• Total bilirubin =< 1.5 x ULN (patients with known Gilbert disease who have serumbilirubin level =< 3 x ULN may be enrolled) (within 14 days prior to registration)

• Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 3 x ULN (ASTand/or ALT =< 5 x ULN for patients with liver involvement) (within 14 days prior toregistration)

• International normalized ratio (INR) and activated partial thromboplastin time (aPTT) =< 1.5 x ULN (or on stable dose of therapeutic anticoagulation, such aslow-molecular-weight heparin, warfarin or rivaroxaban) (10/16/2017)

• Thyroid-stimulating hormone (TSH) within normal limits (Euthyroid patients onthyroid replacement therapy allowed provided TSH < ULN) (02/20/2019)

• The patient or legally authorized representative must provide study-specificinformed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information

Exclusion Criteria:

• Patients with prior allogeneic bone marrow transplantation or prior solid organtransplantation

• Patients who have had systemic anticancer therapy (e.g., chemotherapy, targetedtherapy including PARP inhibitors or bevacizumab) within 3 weeks prior to enteringthe study (30-OCT-2020)

• Patients who have had hormonal therapy (e.g., tamoxifen, aromatase inhibitor) within 1 week prior to entering the study

• Patients with prior treatment with anti-programmed cell death (PD)-1, anti-programmed cell death ligand (PD-L)1 or anti-cytotoxic T-lymphocyte-associatedprotein (CTLA)-4 therapeutic antibody or other similar agents (10/16/2017)

• Patients with prior treatment with bevacizumab (or any other anti vascular therapy,e.g., cediranib) for platinum resistant recurrence; (Note: prior bevacizumab ininitial therapy and/or platinum sensitive recurrent setting is allowed) (10/16/2017)

• Patients with prior treatment with PLD

• Prior radiotherapy to the abdomen or pelvis

• Patients who have not recovered from adverse events to =< grade 1 (other thanalopecia) due to agents administered more than 3 weeks earlier (10/16/2017);however, the following therapies are allowed:

• Hormone replacement therapy or oral contraceptives

• Herbal therapy > 1 week prior to cycle 1, day 1 (herbal therapy intended asanticancer therapy must be discontinued at least 1 week prior to cycle 1, day

• Palliative radiotherapy for bone metastases > 2 weeks prior to cycle 1, day 1

• Treatment with any other investigational agent within 4 weeks prior to cycle 1, day 1

• Treatment with systemic immunostimulatory agents (including, but not limited to,interferon [IFN]-alpha or interleukin [IL]-2) within 6 weeks prior to cycle 1, day 1

• Treatment with systemic immunosuppressive medications (including, but not limitedto, prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, andanti-tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to cycle 1, day 1

• Patients who have received acute, low dose, systemic immunosuppressantmedications (e.g., a one-time dose of dexamethasone for nausea or steroids ascomputed tomography [CT] scan contrast premedication) may be enrolled

• The use of inhaled corticosteroids and mineralocorticoids (e.g.,fludrocortisone) for patients with orthostatic hypotension or adrenocorticalinsufficiency is allowed

• Patients taking bisphosphonate therapy for symptomatic hypercalcemia within the past 28 days; use of bisphosphonate therapy for other reasons (e.g., bone metastasis orosteoporosis) is allowed

• Patients with known primary central nervous system (CNS) malignancy or symptomaticCNS metastases are excluded, with the following exceptions:

• Patients with asymptomatic untreated CNS disease may be enrolled, provided allof the following criteria are met:

• Evaluable or measurable disease outside the CNS

• No metastases to brain stem, midbrain, pons, medulla, cerebellum, orwithin 10 mm of the optic apparatus (optic nerves and chiasm)

• No history of intracranial hemorrhage or spinal cord hemorrhage

• No ongoing requirement for dexamethasone for CNS disease; patients on astable dose of anticonvulsants are permitted

• No neurosurgical resection or brain biopsy within 28 days prior to cycle 1, day 1

• Patients with asymptomatic treated CNS metastases may be enrolled, provided allthe criteria listed above are met as well as the following:

• Radiographic demonstration of improvement upon the completion of CNSdirected therapy and no evidence of interim progression between thecompletion of CNS directed therapy and the screening radiographic study

• No stereotactic radiation or whole-brain radiation within 28 days prior tocycle 1, day 1

• Screening CNS radiographic study >= 4 weeks from completion ofradiotherapy and >= 2 weeks from discontinuation of corticosteroids

• Known hypersensitivity to Chinese hamster ovary cell products or other recombinanthuman antibodies

• History of severe allergic, anaphylactic, or other hypersensitivity reactions tochimeric or humanized antibodies or fusion proteins

• Patients requiring treatment with a receptor activator of nuclear factor kappa-Bligand (RANKL) inhibitor (e.g. denosumab) who cannot discontinue it before treatmentwith atezolizumab

• Known clinically significant liver disease, including active viral, alcoholic, orother hepatitis; cirrhosis; fatty liver; and inherited liver disease

• Patients with past or resolved hepatitis B infection (defined as having anegative hepatitis B surface antigen [HBsAg] test and a positive anti-HBc [antibody to hepatitis B core antigen] antibody test) are eligible

• Patients positive for hepatitis C virus (HCV) antibody are eligible only ifpolymerase chain reaction (PCR) is negative for HCV ribonucleic acid (RNA)

• History or risk of autoimmune disease, including but not limited to systemic lupuserythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosisassociated with antiphospholipid syndrome, Wegener's granulomatosis, Sjogren'ssyndrome, Guillain-Barre syndrome, multiple sclerosis, autoimmune thyroid disease,vasculitis, or glomerulonephritis (02/20/2019)

• Patients with a history of autoimmune hypothyroidism on a stable dose ofthyroid replacement hormone are eligible

• Patients with controlled type 1 diabetes mellitus on a stable insulin regimen,or type 2 diabetes mellitus are eligible

• Patients with eczema, psoriasis, lichen simplex chronicus or vitiligo withdermatologic manifestations only (e.g., patients with psoriatic arthritis wouldbe excluded) are permitted provided that they meet the following conditions:

• Patients with psoriasis must have a baseline ophthalmologic exam to ruleout ocular manifestations

• Rash must cover less than 10% of body surface area (BSA)

• Disease is well controlled at baseline and only requiring low potencytopical steroids (e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%,fluocinolone 0.01%, desonide 0.05%, alclometasone dipropionate 0.05%)

• No acute exacerbations of underlying condition within the last 12 months (not requiring psoralen plus ultraviolet A radiation [PUVA], methotrexate,retinoids, biologic agents, oral calcineurin inhibitors; high potency ororal steroids)

• History of idiopathic pulmonary fibrosis, pneumonitis (including drug induced),organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizingpneumonia, etc.), or evidence of active pneumonitis on screening chest computedtomography (CT) scan; history of radiation pneumonitis in the radiation field (fibrosis) is permitted

• Patients with active tuberculosis (TB) are excluded

• Severe infections within 4 weeks prior to cycle 1, day 1, including but not limitedto hospitalization for complications of infection, bacteremia, or severe pneumonia

• Signs or symptoms of infection within 2 weeks prior to cycle 1, day 1

• Received oral or intravenous (IV) antibiotics within 2 weeks prior to cycle 1, day 1; patients receiving prophylactic antibiotics (e.g., for prevention of a urinarytract infection or chronic obstructive pulmonary disease) are eligible

• Major surgical procedure within 28 days prior to cycle 1, day 1 or anticipation ofneed for a major surgical procedure during the course of the study

• Administration of a live, attenuated vaccine within 4 weeks before cycle 1, day 1 oranticipation that such a live, attenuated vaccine will be required during the studyand up to 5 months after the last dose of atezolizumab (06/29/2017)

• Influenza vaccination should be given during influenza season only (approximately October to March); patients must not receive live, attenuatedinfluenza vaccine within 4 weeks prior to cycle 1, day 1 or at any time duringthe study

• Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements

• Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviraltherapy with undetectable viral load within 6 months are eligible for this trial (08-JAN-2021)

• Prior invasive malignancy (except non-melanomatous skin cancer) unless disease freefor a minimum of 3 years, with the exception of those with a negligible risk ofmetastases or death, such as carcinoma in situ of the breast or cervix

• Severe, active co-morbidity defined as follows:

• Current (within 28 days of cycle 1, day 1) signs and/or symptoms of bowelobstruction

• Patients who require parental hydration and/or nutrition

• Patients who require drainage gastrostomy tube

• Evidence of bleeding diathesis or clinically significant coagulopathy

• Serious, non-healing or dehiscing wound, active ulcer or untreated bonefracture

• History of hemoptysis (>= 1/2 teaspoon of bright red blood per episode) within 1 month of study enrollment

• Significant cardiovascular or cerebrovascular disease including:

• Uncontrolled hypertension (systolic blood pressure [SBP] >= 150 and/ordiastolic blood pressure [DBP] >= 90)

• History of myocardial infarction within 6 months

• Unstable angina

• New York Heart Association functional classification II, III or IV

• Baseline ejection fraction =< 50% as assessed by echocardiogram or multi-gatedacquisition (MUGA)

• Cerebral vascular accident (CVA) or transient ischemic attack (TIA) within 6months

• Significant vascular disease (e.g., aortic aneurysm, requiring surgical repairor peripheral arterial thrombosis) within 6 months

• History of abdominal/pelvic or tracheoesophageal fistula or gastrointestinalperforation and/or abdominal/pelvic abscess within 6 months prior to initiation oftreatment (02/20/2019)

• Pregnant or lactating patients