Neoadjuvant Ficerafusp Alfa With Pembrolizumab in Resectable SCC

Neoadjuvant Ficerafusp Alfa With Pembrolizumab in Resectable Squamous Cell Carcinoma of the Head and Neck: a Phase 2 Trial

This trial is to evaluate the safety and efficacy of ficerafusp alfa in combination with pembrolizumab prior to surgical resection in participants with resectable, high-risk, locoregionally advanced, PD-L1-positive squamous cell carcinoma of the head and neck (HNSCC).

The names of the study drugs used in this research study are:

• ficerafusp alfa (a type of bifunctional antibody and recombinant fusion protein)
• pembrolizumab (a type of monoclonal antibody)

Study Overview

• Status: Recruiting
• Conditions: Squamous Cell Carcinoma of the Head and Neck; Head and Neck Squamous Cell Carcinoma (HNSCC)
• Intervention / Treatment: Drug: Ficerafusp alfa; Drug: Pembrolizumab

Detailed Description

This open-label, non-randomized, phase 2 clinical trial is to evaluate the safety and efficacy of ficerafusp alfa in combination with pembrolizumab prior to surgical resection in participants with resectable, high-risk, locoregionally advanced, PD-L1-positive squamous cell carcinoma of the head and neck.

The U.S. Food and Drug Administration (FDA) has not approved ficerafusp alfa as treatment for resectable, high-risk, locoregionally advanced, PD-L1-positive squamous cell carcinoma of the head and neck.

The FDA has approved pembrolizumab as treatment for resectable, high-risk, locoregionally advanced, PD-L1-positive squamous cell carcinoma of the head and neck.

The research study procedures include screening for eligibility, in-clinic visits, blood tests, urine tests, tumor biopsies, and Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, or Positron Emission (PET) scans.

It is expected that about 32 people will take part in this research study. Bicara Therapeutics is supporting this research study by providing an investigational supply of Ficerafusp alfa.

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Glenn Hanna
• Study Contact Backup: Name: Glenn Hanna; Phone Number: 617-632-3779; Email: Gjhanna@partners.org

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Dana-Farber Cancer Institute
      • Principal Investigator: Glenn Hanna
      • Contact: Glenn Hanna; Phone Number: 617-632-3779; Email: Gjhanna@partners.org
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Brigham and Women's Hospital
      • Contact: Glenn Hanna; Phone Number: 617-632-3779; Email: Gjhanna@partners.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants must have histologically or cytologically confirmed, untreated and newly diagnosed, locoregionally advanced head and neck squamous cell carcinoma (HNSCC) arising from oral cavity, oropharynx (with documented HPV-negative disease if presenting with oropharyngeal SCC), larynx, or hypopharynx.
• Participants should have resectable disease at baseline per the discretion of the treating surgical oncologist.

• Participants must have clinical stage disease as defined below using the 8th (2017) edition of the tumor, node, metastasis (TNM) staging system by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC):

  • T1-2, N1-3: III
  • T3, any N: III, IVA, IVB
  • T4, any N: IVA, IVB
• Tumor must be PD-L1 positive with a CPS score equal to 1 or greater (by any approved assay or scoring method).
• Participants must be willing to provide blood and tissue pre-treatment and at the time of surgery for pathologic and correlative analyses. Specifically, willingness to provide a newly obtained core or excisional biopsy of a tumor lesion from the primary tumor site.
• Age 18 years or older at the time of informed consent.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

• Participants must have adequate organ and marrow function as defined below:

  • absolute neutrophil count ≥1500/mcL
  • platelets ≥100 x 109/L
  • total serum bilirubin ≤1.5X upper limit of normal (ULN) (except for subjects with documented Gilbert syndrome) and AST (SGOT) and ALT (SGPT) ≤2.5X ULN
  • AST(SGOT) / ALT (SGPT) ≤3X ULN
  • Creatinine ≤institutional ULN or GFR of ≥30 mL/min/1.73 m2
  • Coagulation PT/INR or activated partial thromboplastin time (aPTT) ≤1.5X ULN unless subject is receiving anticoagulant therapy
• Female participants of childbearing potential should have a negative urine or serum pregnancy test within 7 days of study registration. Female subjects of childbearing potential should have a negative urine or serum pregnancy test repeated within 72 hours prior to receiving the first dose of study medication.
• Female participants of childbearing potential having sex with an unsterilized male partner must agree to use a highly effective method of contraception from the beginning of screening until 120 days after the last dose of study drugs.
• Unsterilized male patient having sex with a female partner of childbearing potential must agree to use an effective method of contraception from the beginning of screening until day 60 after the last dose of study drugs.
• Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Recurrent or metastatic (M1 or IVC disease by AJCC 2017 8th edition staging) HNSCC or very early-stage HNSCC (stage I or II by AJCC 2017 8th edition staging); or head and neck cancer arising at other primary subsites such as the skin, paranasal sinuses, nasal cavity, or salivary glands.
• HPV-associated oropharyngeal cancer (as determined by p16 positivity by immunohistochemistry and/or confirmatory HPV RNA ISH or PCR testing, or by plasma HPV DNA testing results).
• Inoperable or surgically unresectable at baseline per the treating investigator(s).
• ECOG performance status of 2 or greater.
• Prior exposure to anti-EGFR antibody or anti-PD-1 immunotherapy.
• Significant bleeding risk peri-operatively at the judgment of the treating investigator(s); such as those with a known bleeding diathesis or experiencing a major bleeding episode within 4 weeks of enrolling to the study.
• Active autoimmune disease requiring systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
• Active systemic infection requiring either hospitalization or parenteral anti-infective therapy within 2 weeks before first dose of study treatment.
• Known psychiatric, behavioral, or substance abuse disorders that would interfere with cooperation of the study requirements.
• Subjects with chronic hepatitis B virus (HBV) infection with active disease who meet the criteria for anti-HBV therapy and are not on a suppressive antiviral therapy prior to initiation of study treatment. Subjects who are hepatitis B surface antigen positive are eligible if they have received HBV antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to randomization. Note: Subjects should remain on antiviral therapy throughout the study treatment period and follow local guidelines for HBV antiviral therapy post completion of study treatment.
• Subjects with a known history of hepatitis C virus (HCV) who have not completed curative antiviral treatment or have an HCV viral load above the limit of quantification at Screening. Note: subjects must have completed curative antiviral therapy at least 4 weeks prior to treatment.
• Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies). HIV testing is not required unless mandated by local health authority.
• Receipt of any organ transplantation, including autologous and allogeneic stem cell transplantation, except for transplants that do not require immunosuppression.
• Known to be diagnosed and/or treated for any other additional malignancy within 2 years prior to registration with the exception of the following: curatively treated basal cell carcinoma or squamous cell carcinoma of the skin, and curatively resected in situ cervical cancer, and curatively resected in situ breast cancer, and low-risk early stage prostate cancer defined as follows: Stage T1c or T2a with a Gleason score ≤6 and prostatic-specific antigen <10 ng/mL either treated with definitive intent or untreated in active surveillance that has been stable. Other exceptions may be considered with the input of the Sponsor-Investigator.
• Any condition requiring systemic treatment with either corticosteroids (>10 mg daily of prednisone or equivalent) or other immunosuppressive medication within 7 days prior to the first dose of study treatment, except for topical, intranasal, intrabronchial, or ocular steroids. Corticosteroid use as premedication for allergic reactions (e.g., intravenous contrast), or as a prophylactic management of AEs related to the therapies specified in the protocol is allowed. The use of physiologic doses of corticosteroids may be approved after consultation with the Sponsor-Investigator.
• Use of a live or live attenuated vaccine within 4 weeks prior to Screening. Note: Administration of killed, recombinant, or inactivated vaccines is allowed.
• Active pregnancy or breastfeeding.
• Unwilling to provide tumor or blood samples for research.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Ficerafusp Alfa plus Pembrolizumab; 32 participants will be enrolled and will complete: Baseline visit; Cycle 1 (21 day cycle):Day 1: predetermined dose of Prembrolizumab 1x daily.Days 1, 8, and 15: predetermined dose of Ficerafusp Alfa 1x daily.; Cycle 2 (21 day cycle):Day 1: predetermined dose of Prembrolizumab 1x daily.Day 1: predetermined dose of Ficerafusp Alfa 1x daily.; Standard of care surgery; End of treatment visit; Follow up for up to 2 years

Drug: Ficerafusp alfa; Bifunctional antibody and recombinant fusion protein, single-use vial, via intravenous (into the vein) infusion per protocol.; Other Names: FmAb2; BCA101; Drug: Pembrolizumab; Monoclonal antibody, single-dose vial, via intravenous infusion per protocol.; Other Names: Keytruda

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pathologic Treatment Response-2 (pTR-2) Rate	pTR-2 rate is defined as ≥50% pathological response of the primary tumor using the surgical specimen following neoadjuvant therapy as established by 2 independent pathologists.	Assessed at time of surgical resection, between days 30 and 42 from start of neoadjuvant treatment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Median Event-free survival (EFS)	EFS is defined as the time from date of surgery to first invasive local, regional, distant recurrence, or death due to any cause. Participants alive without disease are censored at date of last disease evaluation. Median EFS is estimated based on the Kaplan-Meier method. Disease recurrence is established by 2 independent pathologists.	Disease assessed every 3 months up to 24 months from date of surgery (+42 days from start of neoadjuvant therapy).
Median Overall Survival	OS is defined as the time from study registration until death due to any cause, or censored at the date last known alive. Median OS is estimated based on the Kaplan-Meier method.	Survival assessed every 3 months up to 24 months from date of surgery (+42 days from start of neoadjuvant therapy).
Pathologic Response Rate by PD-LI Combined positive score (CPS) Subgroup	Pathologic response rate is defined as ≥50% pathological response of the primary tumor using the surgical specimen following neoadjuvant therapy as established by 2 independent pathologists. PD-LI expression will be evaluated per established methods and PD-LI CPS ranges from 0-100.	Assessed at time of surgical resection, between days 30 and 42 from start of neoadjuvant treatment.
Major Pathologic Response Rate	MPR rate is defined as the percentage of participants with ≥90% pathological response of the primary tumor and lymph nodes using the surgical specimen following neoadjuvant therapy as established by 2 independent pathologists.	Assessed at time of surgical resection, between days 30 and 42 from start of neoadjuvant treatment.
Pre-Operative Objective Response Rate (ORR)	Pre-operative ORR is the percentage of participants achieving complete or partial response on neoadjuvant treatment based on RECIST v1.1 criteria (Eisenhauer et al Eur J Ca 45:228-247, 2009).	Assessed over 2 cycles of neoadjuvant treatment (cycle duration=21 days), up to day 42.

Collaborators and Investigators

• Sponsor: Dana-Farber Cancer Institute
• Collaborators: Bicara Therapeutics
• Investigators: Principal Investigator: Glenn Hanna, Dana-Farber Cancer Institute

Study record dates

Study Major Dates

• Study Start (Actual): March 26, 2026
• Primary Completion (Estimated): April 30, 2028
• Study Completion (Estimated): April 30, 2030

Study Registration Dates

• First Submitted: March 6, 2026
• First Submitted That Met QC Criteria: March 6, 2026
• First Posted (Actual): March 11, 2026

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 26, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Neoplasms by Histologic Type; Head and Neck Neoplasms; Neoplasms, Glandular and Epithelial; Carcinoma; Carcinoma, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; pembrolizumab
• Other Study ID Numbers: 25-829

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
• IPD Sharing Time Frame: Data can be shared no earlier than 1 year following the date of publication
• IPD Sharing Access Criteria: Contact the Belfer office for Dana -Farber Innovations (BODFI) at innovations@dfci.harvard.edu
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No