Cancers of the head and neck can be treated with several drugs on the market, but for certain patients diagnosed with this this common type of cancer, outcomes are worse and better therapeutic options are needed. Bicara Therapeutics is developing a therapy that could provide a treatment alternative and the company now has $315 million in IPO cash to finance a pivotal study.
Boston-based Bicara was able to raise more than it planned. In preliminary IPO terms set on Monday, the company aimed to offer 11.7 million shares priced in the range of $16 to $18 each. On Wednesday, Bicara increased the proposed stock sale to 14.7 million shares offered in the same targeted price range. When shares finally priced late Thursday, Bicara boosted the deal size yet again, offering 17.5 million shares for $18 each, right at the top of the targeted price range. Those shares now trade on the Nasdaq under the stock symbol “BCAX.”
Most head and neck squamous cell carcinoma (HNSCC) cases come from exposure to carcinogens such as tobacco smoke or from human papillomavirus (HPV), Bicara says in its IPO filing. That virus can lead to cellular changes that over time, become precancerous and then cancerous. However, an estimated 80% of recurrent or metastatic HNSCC cases are HPV-negative. These tumors are associated with an increased risk of fatal tumor bleeding, excruciating pain, and difficulty swallowing.
What’s Keeping Healthcare CIOs Up at Night: How to Improve Patient Satisfaction by Handling Calls More Efficiently
Health systems have spent billions on portals while investments in modernizing the voice channel — the dominant preference of healthcare consumers — have taken a backseat.
Bicara’s drugs are antibodies engineered to address solid tumors by hitting two validated cancer targets. The company’s lead program, ficerafusp alfa, is a bifunctional antibody drug designed to bind to epidermal growth factor receptor (EGFR) and human transforming growth factor beta (TGF-beta).
TGF-beta is an important target because high signaling from this protein is associated with resistance to the class of immunotherapies called checkpoint inhibitors. For that reason, drugs that hit this target have been tested as a way to potentially overcome this resistance. GSK and Merck KGaA tried this approach with a bifunctional protein, bintrafusp alfa. But clinical trial results showed the experimental therapy fell short on measures of efficacy. In its IPO filing, Bicara said such failures may be due to insufficient anti-tumor activity, possibly because the immunotherapy is being expressed in immune tissue rather than the tumor microenvironment (TME) where it’s needed.
Bicara says the dual approach of its drug blocks survival signaling from EGFR as well as immunosuppressive TGF-beta signaling in the TME. Bicara has been testing its experimental drug in combination with the blockbuster Merck immunotherapy pembrolizumab, brand name Keytruda, whose approved indications include HNSCC. An ongoing Phase 1/1b study of the Bicara drug includes a group of HNSCC patients who had not previously received treatment after their cancer had advanced. In this cohort, Bicara said the combination of the study drug and Keytruda led to a 54% overall response rate in patients who could be evaluated for efficacy. In patients whose disease was HPV negative, the overall response rate was 64%. For context, the historical response rate in a Phase 3 test of Keytruda monotherapy in HNSCC was 19%, the company said in the filing. The company expects to report more Phase 1/1b data at a medical meeting in 2025.
“Based on the clinical data generated to date, we believe that ficerafusp alfa in combination with pembrolizumab has the potential to become a first-line standard of care therapy in HPV-negative [recurrent/metastatic] HNSCC,” Bicara said in the filing. “We also believe ficerafusp alfa has the potential to provide meaningful clinical benefit in other solid tumors where there is a strong biologic rationale for the dual inhibition of both EGFR and TGF-beta, such as colorectal cancer and other squamous cell carcinomas which typically overexpress EGFR and TGF-beta pathways.”
What Healthcare Can Learn from Costco
The path forward is clear: employers must evaluate their health plan the same way they do their Saturday shopping excursion.
A pivotal Phase 2/3 clinical trial is planned that will test the Bicara therapy in combination with the Merck immunotherapy pembrolizumab, brand name Keytruda, as a first-line treatment for advanced HNSCC. Bicara expects this study will start by the end of this year or in the first quarter of 2025.
Bicara formed in 2018. The following year, the company licensed certain fusion proteins from Biocon Limited. The most advanced of those fusion proteins was ficerasfusp alfa. There are no future milestone payments or royalties tied to the deal, Bicara said in the filing. The prospectus says Bicara has raised $353.1 million since its inception. The most recent financing was a $165 million Series C round announced last December. Biocon is Bicara’s largest shareholder, owning an 11.28% post-IPO stake, according to the filing. RA Capital Management owns a 10.5% stake after the IPO.
As of the end of the second quarter of this year, Bicara reported a cash position of $203.9 million. Combined with the IPO proceeds, the company plans to spend about $265 million on the development of ficerafusp alfa in HNSCC, including the pivotal study and the filing of a biologics license application. Another $30 million is earmarked for the expansion of its lead drug candidate in additional HNSCC patient groups. And $25 million is set aside for advancing clinical development of the drug in additional types of solid tumors, such as colorectal cancer and other squamous cell carcinomas.
Zenas’s IPO Pulls in $225M for Pipeline in a Product Opportunity in I&I
Zenas Biopharma, a company developing antibody drugs to treat immunology and inflammation (I&I) disorders, raised $225 million. The company late Thursday priced more than 13.23 million shares at $17 each. When Zenas set preliminary financial terms this week, it aimed to offer 11.76 million shares in the range of $16 to $18 apiece, which would have raised $199.9 million at the pricing midpoint. Zenas’s shares will trade on the Nasdaq under the stock symbol “ZBIO.”
Excessive activity of B cells, a type of immune cell, is associated with a range of autoimmune disorders. While antibody drugs are currently available that treat these conditions by depleting B cells, Zenas contends they don’t fully affect B cells in relevant tissue and the dosing regimen of these therapies can be improved. Another concern is that antibody drugs that target and block the proteins CD19 and CD20 on B cells may deplete these cells for six months or longer, which raises the risk of infection and could reduce a patient’s ability to respond to and benefit from vaccines.
Zenas’s lead drug candidate is obexelimab, a bifunctional antibody designed to bind to CD19 and Fc gamma receptor IIb, both targets that are broadly expressed on B cells. According to Zenas, this approach mimics a natural antigen-antibody complex for inhibiting B cells. This mechanism of action is intended to inhibit the activity of B cells without completely depleting them. Zenas acquired global rights to obexelimab from Xencor in 2021. The company had previously licensed other programs from Xencor; those programs are still preclinical.
While Zenas believes obexelimab has broad potential in I&I, the company is initially focusing on four indications: immunoglobulin G4-related disease (IgG4-RD), multiple sclerosis, systemic lupus erythematosus, and warm autoimmune hemolytic anemia (wAIHA). Zenas’s drug is furthest along in IgG4-RD, a chronic inflammatory condition that affects multiple organs. Standard of care includes corticosteroids. Roche’s CD20-targeting antibody drug, Rituxan, can also be used to treat the condition. Zenas is continuing a Phase 3 test of its lead drug in IgG4-RD.
Since inception, Zenas said it had raised $358.3 million from investors. The company’s most recent financing was a $200 million Series C round in May led by SR One. That investor owns a 7% post-IPO stake in Zenas, according to the filing. Xencor is Zenas’s largest shareholder with an 8.1% post-IPO stake.
As of the end of June, Zenas reported having $183.9 million in cash. That capital, along with the IPO proceeds, will broadly support the advancement of obexelimab. Zenas plans to spend about $100 million on clinical development of the drug, including the completion of a Phase 3 study in patients with IgG4-RD. This drug candidate will also be evaluated in separate Phase 2 tests in multiple sclerosis, lupus, and wAIHA. The company expects its capital will last for the next two years.
MBX Bio’s Longer-Acting Peptide Drugs Land $163M for Clinical Trials
MBX Biosciences’ IPO raised $163 million for a pipeline that includes a lead program in the clinic for a rare hormone deficiency with few FDA-approved treatments. Carmel, Indiana-based MBX priced its offering of 10.2 million shares at $16 each, which was the top of $14 to $16 per share price range it set earlier this week. The company was able to boost the deal size, offering 1.7 million more shares than it had initially planned. MBX’s shares will trade on the Nasdaq under the stock symbol “MBX.”
MBX’s drugs come from a platform technology that engineers peptides with a longer duration of action that enables less frequent dosing intervals. This technology is based on research from Indiana University. Lead program MBX 2109 is a potential treatment for chronic hypoparathyroidism, a condition in which the parathyroid glands do not produce enough parathyroid hormone to regulate levels of calcium and phosphate in the blood.
The first FDA-approved therapy for this condition is Takeda Pharmaceutical’s Natpara, an engineered version of the hormone. But Takeda has said it will stop offering Natpara due to ongoing manufacturing problems. Patients have a new alternative following FDA approval last month of Ascendis Pharma’s Yorvipath, a peptide injected once-daily to bring parathyroid hormone levels within the normal range.
With MBX 2109, MBX aims to offer chronic hypoparathyroidism patients less burdensome once-weekly dosing. In Phase 1 testing, the company reported its engineered peptide achieved parathyroid hormone levels comparable to those achieved by a continuous infusion. A Phase 2 study dosed its first patient last month; preliminary data are expected in the third quarter of next year.
Another engineered peptide, MBX 1416, is in Phase 1 development for post-bariatric hypoglycemia (PBH). In this rare condition, bariatric surgery patients go on to develop dangerously low blood sugar levels. There are no FDA-approved therapies for this rare condition, but MBX isn’t alone in the pursuit for one. Amylyx Pharmaceuticals picked up its Phase 3-ready PBH peptide drug from the bankruptcy auction of Eiger BioPharmaceuticals. Another engineered peptide, MBX 4291, is in preclinical development for obesity.
According to the IPO filing, MBX’s cash position at the end of June was $55.3 million. That capital, along with the IPO proceeds, will support clinical trials. MBX plans to spend $148.6 million to take its lead program through mid-stage development and into Phase 3 testing in chronic hypoparathyroidism and to advance its PBH drug through Phase 1 and Phase 2 testing. Another $31.2 million is set aside to advance the obesity program into the clinic.
Photo: Getty Images