Background Technically resectable locally advanced head and neck squamous cell carcinoma may require highly morbid surgery. We evaluated short‐course neoadjuvant anlotinib plus paclitaxel–cisplatin as a signal‐generating strategy. Methods Twenty‐one patients received two 21‐day cycles in a prospective, single‐arm Phase II study. The primary endpoint was RECIST 1.1 objective response rate; pathological response and surgical extent were exploratory. Results Objective response rate was 66.7% (14/21; 95% CI, 43.0%–85.4%), meeting the prespecified activity criterion. Eight patients underwent surgery; all achieved R0 resection, 5/8 achieved major pathological response, and 4/8 underwent less extensive resection than initially planned. Documented adverse events were mainly Grade 1, including one Grade 1 hypertension controlled with levamlodipine and one Grade 2 primary‐tumor bleeding event; proteinuria was not systematically captured. Conclusions The regimen generated antitumor activity and surgical feasibility signals but does not establish anlotinib benefit beyond TP or functional preservation. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2100046440
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