Atezolizumab and Stereotactic Body Radiation Therapy in Treating Patients With Non-small Cell Lung Cancer

Inclusion Criteria

• •Histologically proven stage I NSCLC =\< 5 cm diameter
• •One or more high-risk features identified:
• •* Tumor diameter \>= 2 cm
• •* Tumor standardized uptake value maximum (SUVmax) \>= 6.2
• •* Moderately, poorly differentiated or undifferentiated histology
• •Evaluable disease per RECIST 1.1
• •Patients must be medically or surgically inoperable as determined by a physician OR unwilling to undergo surgical resection
• •All patients must have an forced expiratory volume in 1 second (FEV1) \>= 700cc
• •All patients must have a carbon monoxide diffusing capability test (DLCO) \>= 5.5 m/min/mmHg
• •Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2
• •Life expectancy \>= 12 months
• •Absolute neutrophil count (ANC) \> 1500 cells/uL
• •White blood cell count (WBC) \> 2500/uL
• •Lymphocyte count \> 500/uL
• •Platelet count \> 100,000/uL
• •Hemoglobin \> 9 g/dL
• •Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 2.5 x upper limit of normal (ULN) with alkaline phosphatase =\< 2.5 x ULN OR AST and ALT =\< 1.5 x ULN, with alkaline phosphatase \> 2.5 x ULN
• •Serum bilirubin =\< 1.0 x ULN
• •International normalized ratio (INR) and activated partial thromboplastin time (aPTT) \< 1.5 x ULN (for patients on anticoagulation they must be receiving a stable dose for at least 1 week prior to enrollment)
• •Creatinine clearance \> 30 mL/min by Cockcroft-Gault formula
• •No history of severe hypersensitivity reactions to other monoclonal antibodies (mAbs)
• •No other active malignancy
• •Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone are eligible
• •Patients with controlled type 1 diabetes mellitus on a stable insulin regimen are eligible
• •Archival tumor sample available; tissue from an fine-needle aspiration (FNA) is allowed but tumor tissue from a core needle biopsy is preferred
• •For female patients of childbearing potential and male patients with partners of childbearing potential agreement (by patient and/or partner) to use highly effective form(s) of contraception (i.e., one that results in a low failure rate \[\< 1% per year\] when used consistently and correctly) and to continue its use for 6 months after the last dose of MPDL3280A
• •Signed informed consent
• •Ability to comply with the protocol