Sponsor: Philogen S.p.A. (industry)
Phase: 2
Start date: Nov. 14, 2025
Planned enrollment: 92
L19IL2 (darleukin; bifikafusp alfa) is an investigational cancer immunotherapy studied alone and in combinations, principally in melanoma. L19IL2 is one drug; Daromun is a combination of L19IL2 and a different drug, L19TNF. Results for the combination cannot establish the effect of L19IL2 alone. (ema.europa.eu)
L19IL2 joins interleukin-2 (IL-2), an immune-stimulating cytokine, to an antibody fragment that binds the extra-domain B of fibronectin. This target is associated with newly formed tumor blood vessels; the design aims to concentrate IL-2 activity at tumors. (ema.europa.eu)
The injected-L19IL2 study reported no serious adverse events. The earlier dacarbazine-combination study described toxicity as manageable and reversible, with no treatment-related deaths. The updated Daromun trial reported no new safety signals; its findings apply to the two-drug combination, not L19IL2 alone. (pubmed.ncbi.nlm.nih.gov)
Last updated: Sep 2026
Goal: To determine the antitumor activity of intratumoral L19IL2 plus L19TNF in locally advanced cutaneous squamous cell carcinoma after progression on or intolerance to immune checkpoint inhibitor therapy, while also characterizing safety and efficacy.
Patients: Adults with histologically confirmed, locally advanced cutaneous squamous cell carcinoma that has progressed on or cannot tolerate immune checkpoint inhibition. Patients must have at least one measurable, injectable cutaneous or subcutaneous lesion; injectable nodal, regional, or in-transit disease is permitted, but visceral metastases are excluded. Other key requirements include ECOG performance status 0–2, adequate hematologic and organ function, and willingness to undergo tumor biopsies. Important exclusions include active systemic anticancer therapy, recent radiotherapy to target lesions, clinically significant cardiovascular disease, active infection, substantial immunosuppression or active autoimmune disease requiring recent systemic treatment, organ transplantation, and pregnancy or breastfeeding.
Design: Open-label, single-arm, multicenter treatment study with no randomization or comparator. Tumor assessments occur at week 8, week 12, every 8 weeks during the first follow-up year, and every 12 weeks during years 2 and 3. Complete response, partial response, or stable disease requires confirmation four weeks later, including histopathologic assessment and independent central review. Follow-up continues for up to 160 weeks after treatment initiation, with overall survival contact every six months after relapse or progression.
Treatments: L19IL2 and L19TNF are administered together by intratumoral injection into all injectable cutaneous, subcutaneous, nodal, or in-transit lesions once weekly for up to four weeks. Patients whose best response is partial response or stable disease may receive a second four-week course at the treating physician’s discretion. The maximum dose per treatment visit is 13 million IU of L19IL2 plus 0.4 mg of L19TNF, with injection volume determined by lesion size and characteristics. L19IL2 is an antibody–cytokine fusion protein targeting the extra-domain B of fibronectin in tumor neovasculature and stroma, thereby localizing IL-2-mediated activation of cytotoxic T cells and natural killer cells; L19TNF uses the same tumor-targeting strategy to deliver TNF. Prior intralesional studies in melanoma have shown responses predominantly in injected lesions, with mostly grade 1–2 local reactions and occasional grade 3 injection-site reactions; early non-melanoma skin cancer data suggest preliminary activity, but efficacy in checkpoint inhibitor-refractory locally advanced cutaneous squamous cell carcinoma remains investigational.
Outcomes: The primary outcome is best overall response rate according to RECIST 1.1, as determined by independent central review, from enrollment through a maximum of 160 weeks after treatment initiation. Responses and stable disease are confirmed by repeat assessment and multiple punch biopsies of treated skin areas. Safety, additional efficacy measures, and overall survival are also followed, although detailed secondary endpoint definitions are not provided.
Burden on patient: Estimated burden is moderate to high. Treatment requires weekly on-site intratumoral injections for four weeks and potentially a second four-week course, with every injectable lesion measured at each visit and injected when feasible. Patients must provide tumor tissue at screening and undergo multiple punch biopsies to confirm response or stable disease. Imaging or clinical tumor assessments are relatively frequent during the first year, followed by visits every 12 weeks in years 2 and 3 and survival contact every six months. The repeated lesion injections, biopsies, prolonged follow-up, and associated travel make participation more demanding than routine surveillance, although there is no placebo arm, randomization, intensive pharmacokinetic sampling, or continuous systemic dosing.
Last updated: Sep 2026
Inclusion Criteria:
* Patients must have histologically documented, locally advanced cSCC.
* Patients must have at least one injectable and measurable cutaneous or subcutaneous lesion.
* Patients must have locally advanced cSCC that has progressed on or cannot tolerate ICI treatment (adjuvant or first line) as assessed by a local multidisciplinary tumor board.
* Patients with nodal, regional or in transit injectable cSCC lesions.
* Patients must be willing to provide tissue from a core or excisional biopsy of a tumor lesion at screening and for confirmation of Objective Response or Stable Disease.
* Male or female patients, who are capable of giving consent, age ≥ 18 years.
* ECOG Performance Status/WHO Performance Status ≤ 2.
* Hemoglobin \> 10.0 g/dL.
* Platelets \> 100 x 109/L.
* ALT and AST, GGT and Lipase ≤ 1.5 x the upper limit of normal (ULN).
* All acute toxic effects (excluding alopecia) of any prior therapy must have resolved to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE v. 5.0) Grade ≤ 1 unless otherwise specified.
* Women of childbearing potential (WOCBP) must have negative pregnancy test results at screening. WOCBP must be using, from screening to three months following the last study drug administration, highly effective contraception methods, as defined by the "Recommendations for contraception and pregnancy testing in clinical trials" issued by the Head of Medicine Agencies' Clinical Trial Facilitation Group and which include, for instance, progesterone-only or combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal occlusion, vasectomised partner.
* Male patients with WOCBP partners must agree to use simultaneously two acceptable methods of contraception (i.e. spermicidal gel plus condom) from the screening to three months following the last study drug administration.
* Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures.
Exclusion Criteria:
* Presence of concomitant malignancies, with the exception of any cancer curatively treated more than 3 years prior to study entry and of tumors with a negligible risk for metastasis or death, such as adequately treated basal cell carcinoma of the skin (surgically removed at least 4 weeks prior to study entry), ductal carcinoma in situ of the breast, or carcinoma in situ of the cervix, early-stage asymptomatic CLL and not under active treatment (Rai 0, Binet A) will be eligible for the study.
* Radiation therapy on the tumor sites in the 4 weeks prior to study drug administration.
* Current topical or systemic chemotherapy, immunotherapy.
* Presence of visceral metastasis.
* disease/infection requiring therapy, including positive tests for human immunodeficiency virus (HIV)-1 or HIV-2 serum antibody, hepatitis B virus (HBV), or hepatitis C virus (HCV). For HBV serology, the determination of HBsAg and anti-HBcAg Ab is required. In patients with serology documenting previous exposure to HBV, negative serum HBV-DNA is required. For HCV, HCV-RNA or HCV antibody test is required. Subjects with a positive test for HCV antibody but no detection of HCV-RNA indicating no current infection are eligible.
* History within the last year of acute or subacute coronary syndromes including myocardial infarction, unstable or severe stable angina pectoris, inadequately treated cardiac arrhythmias and heart insufficiency (any grade, New York Heart Association (NYHA) criteria).
* Any abnormalities observed during baseline ECG investigations that are considered clinically significant by the investigator.
* Known arterial aneurysms.
* Chronically impaired renal function as indicated by creatinine clearance \< 60 mL/min/1.73m2 or for patients older than 65 years without albuminuria or proteinuria, creatinine clearance \< 45 mL/min/1.73m2.
* INR \> 3.
* Uncontrolled hypertension.
* Known uncontrolled coagulopathy or bleeding disorder.
* Known hepatic cirrhosis or severe pre-existing hepatic impairment.
* Moderate to severe respiratory failure.
* Active autoimmune disease that has required systemic treatment in past 2 years.
* Patients have a diagnosis of immunodeficiency or are receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions and asthma/COPD is not considered an exclusion criterion.
* Known history of allergy to IL2, TNF, or other human proteins/peptides/antibodies.
* Pregnancy or breast-feeding.
* Ischemic peripheral vascular disease (Grade IIb-IV).
* Severe diabetic retinopathy.
* Recovery from major trauma including surgery within 4 weeks prior to enrollment.
* Solid organ transplant recipient or patient with iatrogenic or pathologic severe immune suppression.
* Patients with a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
* Patients who have received a live vaccine within 30 days prior to the first dose of study drug. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guérin, and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., FluMist®) are live attenuated vaccines and are not allowed.
* Any conditions that in the opinion of the investigator could hamper compliance with the study protocol.
Berlin, 10117, Germany
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Status: Recruiting
Augsburg, 86179, Germany
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Essen, 45147, Germany
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Halle, 06120, Germany
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Heidelberg, 69120, Germany
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Kiel, 24105, Germany
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Tübingen, 72076, Germany
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Siena, 53100, Italy
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Status: Recruiting
Roma, 00168, Italy
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Status: Recruiting
Rozzano, 20089, Italy
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Status: Recruiting
Naples, 80131, Italy
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Status: Recruiting
Barcelona, 08036, Spain
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Status: Recruiting
Orange, California, 92868-3201, United States
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Status: Recruiting
Atlanta, Georgia, 30322, United States
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Status: Recruiting
Boston, Massachusetts, 02215, United States
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Status: Recruiting
Durham, North Carolina, 27710, United States
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Status: Recruiting
Houston, Texas, 77030, United States
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Status: Recruiting
Athens, 16121, Greece
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Status: Not yet recruiting
Columbus, Ohio, 43210, United States
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Status: Not yet recruiting