Bicara Therapeutics (NASDAQ:BCAX) executives reviewed new clinical data for ficerafusp alfa (FICERA) from the 2026 Multidisciplinary Head and Neck Cancer Symposium (MHNCS), highlighting preliminary results from a less frequent dosing regimen and outlining plans to explore a loading-and-maintenance schedule intended to improve convenience while preserving efficacy.
Program focus and mechanism
Chief Executive Officer Claire Mazumdar described ficerafusp alfa as “the first and only” bifunctional EGFR-directed antibody combined with a TGF-β ligand trap designed to drive tumor penetration. Mazumdar said the EGFR arm is intended to localize TGF-β inhibition within tumors and help reduce fibrosis, immunosuppression, and T-cell exclusion, while also reversing TGF-β-driven resistance mechanisms observed with EGFR and checkpoint inhibitor treatments.
FORTIFI-HN01 status and dose selection
Mazumdar reiterated that the pivotal FORTIFI-HN01 study began with a Phase II dose optimization portion aligned with FDA Project Optimus expectations. Patients were randomized to 1,500 mg ficerafusp alfa weekly plus pembrolizumab, 750 mg weekly plus pembrolizumab, or placebo plus pembrolizumab. She said the company has aligned with the FDA that 1,500 mg weekly is the “go-forward” dose for the Phase III portion.
According to Mazumdar, the trial has now moved into the Phase III stage without pausing enrollment, and patients are being randomized 2-to-1 to 1,500 mg weekly ficerafusp alfa plus pembrolizumab versus standard-of-care pembrolizumab. She added that the first patients treated at the 1,500 mg dose will be included in both an objective response rate (ORR) analysis intended to support potential accelerated approval and in the final overall survival analysis intended to support full approval.
New exploratory cohort: 2,000 mg every other week plus pembrolizumab
Executive Vice President of Clinical Development Bill Schelman reviewed preliminary findings from a Phase I-b expansion cohort evaluating ficerafusp alfa 2,000 mg every other week in combination with pembrolizumab in frontline HPV-negative recurrent or metastatic HNSCC patients with CPS ≥1. Schelman emphasized the cohort’s high disease burden, including a “significant proportion” with bulky tumors measuring 5 cm or greater and more than 80% with locoregional recurrence (alone or with distant metastases).
On safety, Schelman said the combination continued to show a “well-tolerated” profile, with no new adverse events observed at the higher 2,000 mg dose and severity consistent with prior experience. He grouped expected events into:
- EGFR-related events such as rash, consistent with other EGFR antibodies like cetuximab.
- Potential TGF-β-related events including mild epistaxis and gingival bleeding that resolved quickly without intervention when observed.
Schelman reported one Grade 4 electrolyte imbalance event (hypokalemia) that was possibly related to ficerafusp alfa, resolved with standard replacement therapy, and did not require dose modification. He also said there were no treatment-related deaths and that discontinuation rates were low.
On preliminary efficacy in 27 efficacy-evaluable HPV-negative patients, Schelman reported:
- 48% confirmed response rate
- 85% disease control rate
- 26% complete response rate
- Median time to response of 1.6 months
He added that 77% of responders achieved greater than 80% tumor shrinkage and said responses appeared robust across CPS subgroups, including CPS 1–19, and across both low and high tumor burden populations. While median duration of response and median progression-free survival were not yet mature, management said “the vast majority of responders” remained in response at the data cutoff, including several beyond 20 months.
Biomarkers and plan to pursue less frequent dosing
Mazumdar discussed internal analyses and biomarker work supporting less frequent dosing. She cited paired tumor biopsies assessing intratumoral TGF-β inhibition via phospho-SMAD2 (baseline and cycle 2 day 1), alongside blood-based cytokine data intended to measure systemic immune activation. She said higher but less frequent dosing continued to show robust TGF-β inhibition and increased immune activation, and she highlighted an increase in T-cell infiltration from baseline to cycle 2 day 1 in patients treated with 2,000 mg every other week.
Management said the company plans to explore a dosing strategy that starts with a loading phase and transitions to an every-three-week maintenance schedule, aligning visit cadence with pembrolizumab. Mazumdar said Bicara expects to initially seek accelerated approval based on the 1,500 mg weekly regimen in FORTIFI-HN01, while running a smaller parallel randomized study to generate loading-and-maintenance data by the time of a potential approval. The company said it will provide more details on the regimen once it achieves regulatory alignment.
Selected Q&A highlights: durability, competition, and safety
In response to analyst questions, management said durability in the 2,000 mg every-other-week cohort appears strong based on a “swimmer plot,” with some early responders showing responses beyond two years, though median duration of response and median PFS were not yet mature. Mazumdar also compared previously disclosed median PFS at 1,500 mg (9.9 months, cited from an ASCO update) to a median PFS of 7.7 months reported for amivantamab plus pembrolizumab in an OrigAMI study presented at the same meeting, stating Bicara believes its 2,000 mg every-other-week data are “trending quite strong” and will exceed that benchmark.
On the Grade 4 hypokalemia event, Schelman said electrolyte imbalances including hypokalemia are consistent with what has been seen with EGFR inhibitors, including cetuximab, and are typically managed with standard replacement therapy.
On trial operations, Mazumdar said FORTIFI-HN01 listed 111 sites on ClinicalTrials.gov and that there was “minimal overlap” with sites running a petosemtamab study (LiGeR-HN1), while an amivantamab study had “just begun recruiting.” She also said market research suggests the therapy’s efficacy profile would support adoption even with weekly dosing, with the proposed maintenance strategy intended to add flexibility and convenience.
About Bicara Therapeutics (NASDAQ:BCAX)
Bicara Therapeutics is a clinical-stage biopharmaceutical company dedicated to developing novel neurohormone-based therapies for psychiatric and neurological disorders. The company’s research focuses on harnessing endogenous signaling pathways in the brain, with the goal of offering new treatment options for conditions that remain inadequately addressed by existing medications. Bicara applies proprietary peptide engineering and intranasal delivery platforms to optimize central nervous system uptake and therapeutic effect.
The company’s lead candidates include PST-001, an intranasal vasopressin-1A receptor antagonist in development for postpartum depression, and PST-002, an oxytocin receptor modulator being investigated for social anxiety and autism spectrum disorder.
