Not yet recruitingNCT07552558Updated Aug 13, 2026

Ficerafusp Alfa, Pembrolizumab, and Stereotactic Body Radiotherapy (SBRT) for Head and Neck Squamous Cell Carcinoma (HNSCC)

A Phase 1/2 interventional study of Hypofractionated Stereotactic Body Radiotherapy (SBRT) and Pembrolizumab in Head and Neck Squamous Cell Carcinoma and HPV-Negative Squamous Cell Carcinoma, sponsored by Washington University School of Medicine. Not yet recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-13.

Sponsored by Washington University School of Medicine · Phase 1/2, Interventional, and Treatment

Phase: Phase 1/2
Study type: Interventional
Enrollment: 45
Allocation: Non-randomized
Ages: 18 Years and older
Sex: All

Study summary

The study is an open-label phase I/II clinical trial. The study will enroll patients to receive neoadjuvant SBRT plus 1 or 2 doses of neoadjuvant pembrolizumab with concurrent ficerafusp alfa (4 doses) prior to definitive surgical resection for high-risk, locoregionally advanced HPV-negative head and neck squamous cell carcinoma (HNSCC). Approximately 6 weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection followed by SOC adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. Adjuvant therapy is not part of this study and therefore is not dictated by study protocol.

Conditions studied

Head and Neck Squamous Cell Carcinoma
HPV-Negative Squamous Cell Carcinoma

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Keywords

Shortened fractionation radiation
Immunotherapy
Curative treatment
Oral cavity cancer
Tongue cancer
Gum cancer
Jaw cancer
Palate cancer
Lip Cancer
Throat cancer
Mouth cancer
Voice box cancer
Head and neck cancer
Oral cancer
Laryngeal cancer
Mandibular cancer
Alveolar ridge cancer
Hypopharyngeal cancer
Oropharyngeal cancer
OPSCC
OCC
OCSCC
HNSCC
Squamous cell carcinoma
Neoadjuvant therapy
Preoperative treatment
Stereotactic body radiotherapy
Radiation therapy
Targeted therapy
Keytruda
BCA101
PD-1 inhibitor
EGFR inhibitor
Checkpoint inhibitor
Locally advance
HP-negative

Who can participate

Ages eligible: 18 Years and older
Sexes eligible: All
Accepts healthy volunteers: No

Inclusion criteria

Newly diagnosed histologically or cytologically confirmed locally advanced, OPC HPV-negative head and neck squamous cell carcinoma (OPSCC) or HNSCC arising from oral cavity, larynx, or hypopharynx.
Baseline resectable disease per the judgment of the treating surgical oncologist.
Clinical stage III, IVA, or IVB disease as defined 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 or
- T3, any N or
- T4, any N
Documented tumor PD-L1 CPS ≥ 1 (by PD-L1 IHC pharmDx assay), determined locally.
Willing to provide blood and newly obtained core or excisional biopsy of tumor lesion pre-treatment and at the time of surgery for pathologic and correlative analyses.
Age 18 years or older at the time of informed consent.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Adequate organ and marrow function as defined below:
- Absolute neutrophil count ≥ 1.5 K/cumm
- Platelets ≥ 100 K/cumm
- Hemoglobin ≥ 9 g/dL (without PRBC transfusion in the prior 7 days)
- Total serum bilirubin ≤ 1.5 x IULN (except for subjects with documented diagnosis of Gilbert syndrome). For subjects with a documented diagnosis of Gilbert's syndrome, total bilirubin must be ≤ 3.0 × ULN, provided that direct bilirubin is within normal limits
- AST(SGOT)/ALT(SGPT) ≤ 2.5 x IULN
- Creatinine clearance (measured or calculated via the Cockcroft-Gault equation or per institutional standards) ≥ 30 mL/min
- PT/INR or aPTT ≤ 1.5 x IULN (except for subjects receiving anticoagulant therapy)
The effects of pembrolizumab and ficerafusp alfa on the developing human fetus are unknown. For this reason, people of childbearing potential and people able to father a child must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 120 days (women) or 90 days (men) after completion of study treatment.
Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants.

Exclusion criteria

Exclusion Criteria:

Currently receiving any other investigational agents.
Prior history of grade ≥ 2 intolerance or hypersensitivity reactions to other murine proteins, or the active substances of ficerafusp alfa, pembrolizumab, or any of their excipients.
At higher risk of bleeding, including known bleeding diathesis or current active major bleeding, or recent major bleeding episode (within 4 weeks prior to enrollment).
Any of the following within 6 months prior to starting study treatment: ST-elevation myocardial infarction, severe/unstable angina, uncontrolled cardiac ventricular arrhythmia, coronary/peripheral artery bypass graft or stent, cerebrovascular accident/stroke less than 6 months prior to enrollment, or congestive heart failure. Subjects with deep vein thrombosis who are hemodynamically stable can enroll if they are on a stable dose of anticoagulants for at least 3 months.
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.
Chronic hepatitis B virus (HBV) infection with active disease meeting the criteria for anti-HBV therapy but not on a suppressive antiviral therapy prior to initiation of study treatment. HBV testing not required in the absence of known history of infection. Note: 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. These subjects should remain on antiviral therapy throughout the study treatment period and follow local guidelines for HBV antiviral therapy post completion of study treatment.
Known history of hepatitis C virus (HCV) infection that has not been cured or that has a detectable viral load. Patients with a history of HCV that has been treated and cured are eligible provided they completed curative antiviral therapy at least 4 weeks prior to initiation of study treatment. Patients with HCV infection who are currently on treatment and have an undetectable HCV viral load are eligible. HCV testing not required in the absence of known history of infection.
Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies) with viral load >0 or CD4\<350. HIV testing is not required in the absence of known history of infection.
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 randomization 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 for the past year prior to study entry. Other exceptions may be considered with the PI's consultation. The time requirement for no malignancy for 2 years does not apply to the cancer for which a subject is enrolled in the study.
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 principle-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.
Pregnant or breastfeeding. People of childbearing potential must have a negative pregnancy test at screening and within 7 days of first dose of study treatment.

Study design

Phase: Phase 1 / Phase 2
Primary purpose: Treatment
Allocation: Non-randomized
Intervention model: Sequential assignment
Masking: None (open label)
Enrollment: 45 participants (estimated)

Study arms

Experimental
Phase 1 Dose Level 1: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level 1 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1, 3, and 5), 2 doses of neoadjuvant pembrolizumab at 200 mg (given on D1 and D22), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines.
Radiation: Hypofractionated Stereotactic Body Radiotherapy (SBRT) · Biological: Pembrolizumab · Drug: Ficerafusp alfa
Experimental
Phase 1 Dose Level -1: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -1 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1, 3, and 5), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines.
Radiation: Hypofractionated Stereotactic Body Radiotherapy (SBRT) · Biological: Pembrolizumab · Drug: Ficerafusp alfa
Experimental
Phase 1 Dose Level -2: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -2 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1 and 4), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines.
Radiation: Hypofractionated Stereotactic Body Radiotherapy (SBRT) · Biological: Pembrolizumab · Drug: Ficerafusp alfa
Experimental
Phase 1 Dose Level -3: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -3 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Day 1), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines.
Radiation: Hypofractionated Stereotactic Body Radiotherapy (SBRT) · Biological: Pembrolizumab · Drug: Ficerafusp alfa
Experimental
Phase 2: Maximum Tolerable Dose (MTD) Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment consists of SBRT beginning on D1 at the dose and number of fractions established in phase I, neoadjuvant pembrolizumab 200 mg at the number of doses established in phase I, and 4 weekly doses of ficerafusp alfa 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines.
Radiation: Hypofractionated Stereotactic Body Radiotherapy (SBRT) · Biological: Pembrolizumab · Drug: Ficerafusp alfa

Interventions

RadiationHypofractionated Stereotactic Body Radiotherapy (SBRT)
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II
BiologicalPembrolizumab
200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Also known as: Keytruda
DrugFicerafusp alfa
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Also known as: BCA101

What researchers measure

Primary outcomes

Phase I only: Maximum tolerated dose (MTD) of SBRT in combination with pembrolizumab plus ficerafusp alfa
The maximum tolerated dose (MTD) is defined as the highest dose level at which 0 or 1 patients of a cohort experience dose-limiting toxicity during the dose limiting toxicity (DLT) window. DLTs are defined in the protocol.
Time frame: From start of treatment until date of surgery (total estimated time of 7 weeks)
Phase II only: Rate of pathologic complete response (pCR)
Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pCR is defined as follows: 100% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes
Time frame: At the time of surgery (estimated to be week 7)

Secondary outcomes

Phase II only: Number and types of Adverse Events (AEs)
As defined by CTCAE v5.0.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
Phase II only: Pathological response rate (PRR)
PRR is categorized as pCR, mPR, and others (pTR-0, pTR-1, pTR-2). Simon's two-stage optimal design will be used for a rate of pCR in phase II. Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pTR is defined as follows: pTR-0: \< 10% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes, pTR-1: 10-49%, pTR-2: 50-89%, pTR-3: 90-99% (also referred to as mPR), and pTR-4: 100% (also referred to as pCR).
Time frame: At time of surgery (estimated to be week 7)
Phase II only: Event-free survival (EFS)
EFS is defined as the time from the first date of treatment to the date of disease progression or death, whichever occurs first.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
Phase II only: Rate of clinical to pathologic down staging (and extent of surgical plan modifications, if any)
Time frame: At time of surgery (estimated to be week 7)
Phase II only: Overall survival (OS)
OS is defined as the time from the first date of treatment to the date of death. Alive patients are censored at the last follow-up otherwise.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)

Study locations

1 site

Washington University School of Medicine
St Louis, Missouri 63110, United States
- Sana Karam, MD, PhD · Contact · sanadkaram@wustl.edu · 314-362-9700
- Sidharth Puram, MD, PhD · Contact · sidpuram@wustl.edu · 314-362-9700
- Sana Karam, MD, PhD · Principal investigator
- Sidharth Puram, MD, PhD · Principal investigator
- Douglas R Adkins, MD · Sub investigator
- Anthony J Apicelli, MD, PhD · Sub investigator
- Christine Auberle, MD · Sub investigator
- Jennifer De Los Santos, MD · Sub investigator
- Hiram Gay, MD · Sub investigator
- Lannis Hall, MD, MPH · Sub investigator
- Yao Hao, PhD · Sub investigator
- R Alex Harbison, MD, MS · Sub investigator
- Ryan S Jackson, MD · Sub investigator
- Brendan J Knapp, MD · Sub investigator
- Esther Lu, PhD · Sub investigator
- Daniel Miller, MD, PhD · Sub investigator
- Peter Oppelt, MD · Sub investigator
- Patrick Pipkorn, MD · Sub investigator
- Nikhil Rammohan, MD, PhD · Sub investigator
- Jason T Rich, MD · Sub investigator
- Robert D Siegel, MD · Sub investigator
- Wade L Thorstad, MD · Sub investigator
- Gregory R Vlacich, MD, PhD · Sub investigator
- Jesse Zaretsky, MD, PhD · Sub investigator
- Paul Zolkind, MD · Sub investigator

References and documents

Individual participant data

Plan to share: No

Registry details

Key details

Study ID: NCT07552558
Lead sponsor: Washington University School of Medicine
Collaborators: Bicara Therapeutics
Responsible party: Sponsor
First posted: Apr 27, 2026
Start date: Sep 30, 2026 (estimated)
Primary completion: Nov 30, 2028 (estimated)
Completion: Nov 30, 2033 (estimated)
Last update: Aug 13, 2026

Study contacts

Sana Karam, MD, PhD

Contact

sanadkaram@wustl.edu

314-362-9700

Sidharth Puram, MD, PhD

Contact

sidpuram@wustl.edu

314-362-9700

Sana Karam, MD, PhD

principal investigator · Washington University School of Medicine

Sidharth Puram, MD, PhD

principal investigator · Washington University School of Medicine

Oversight

Data monitoring committee: Yes
FDA-regulated drug: Yes
FDA-regulated device: Yes

View the source record on ClinicalTrials.gov ↗

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