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Nadofaragene firadenovec
Nadofaragene firadenovec, sold under the brand name Adstiladrin, is a gene therapy for the treatment of bladder cancer.[1][3][4] It is a non-replicating (cannot multiply in human cells) adenoviral vector-based gene therapy.[3] The most common adverse events including laboratory abnormalities, include increased glucose, instillation site discharge, increased triglycerides, fatigue, bladder spasm, micturition urgency, increased creatinine, hematuria, decreased phosphate, chills, dysuria, and pyrexia.[4] Nadofaragene firadenovec was approved for medical use in the United States in December 2022.[3][4][5] Medical usesNadofaragene firadenovec is indicated for the treatment of adults with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors.[1][3] HistoryThe safety and effectiveness of nadofaragene firadenovec was evaluated in a multicenter clinical study (Study CS-003 (NCT02773849)) that included 157 participants with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer, 98 of whom had BCG-unresponsive carcinoma in situ with or without papillary tumors and could be evaluated for response.[3][4] Participants received nadofaragene firadenovec once every three months for up to twelve months, or until unacceptable toxicity to therapy or recurrent high-grade non-muscle-invasive bladder cancer.[3][4] Overall, 51% of enrolled participants using nadofaragene firadenovec therapy achieved a complete response (the disappearance of all signs of cancer as seen on cystoscopy, biopsied tissue, and urine).[3] The median duration of response was 9.7 months.[3] Forty-six percent of responding participants remained in complete response for at least one year.[3] The major efficacy outcome measures were complete response at any time and duration of response.[4] Complete response was defined as negative cystoscopy with applicable transurethral resection of bladder tumor and biopsies and urine cytology.[4] Random bladder biopsies of five sites were conducted in participants remaining in complete response at twelve months.[4] The US Food and Drug Administration (FDA) granted the application for nadofaragene firadenovec priority review, breakthrough therapy, fast track, and orphan drug designations.[3][4] The FDA granted approval of Adstiladrin to Ferring Pharmaceuticals A/S.[3] Society and cultureNamesNadofaragene firadenovec is the international nonproprietary name (INN).[6] References
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