Nadofaragene Firadenovec-vncg (Adstiladrin®- Given into the bladder)

Author: Karen Arnold-Korzeniowski, MSN RN
Content Contributor: Christopher Tweed, PharmD, BCOP
Last Reviewed: December 29, 2022

Pronounce: na-do-FAR-a-jean fear-ah-DEN-o-vec vncg

Classification: Gene Therapy

About: Nadofaragene Firadenovec-vncg (Adstiladrin®- Given into the bladder)

Nadofaragene Firadenovec-vncg is a non-replicating adenoviral vector-based gene therapy. The treatment delivers the human interferon alfa-2b gene, which is non-replicating, to the cells in your bladder wall. The interferon alfa-2b gene has anti-tumor effects. The gene therapy increases the level and length of time your bladder wall is exposed to interferon alfa-2b protein which helps treat your cancer.

How to Take Nadofaragene Firadenovec-vncg

This medication is given directly into the bladder (called intravesicular), through a catheter, and left in the bladder for 1 hour. You may be asked to change your position every 15 minutes. The dosage and schedule are determined by your healthcare provider.

There is a risk of metastatic cancer if a cystectomy is delayed due to this treatment. Talk with your provider about which treatments are best for you. This medication can also increase the risk of disseminated adenovirus infection in those who are immunocompromised.

How the Intravesicular Treatment is Given

  • You should limit your fluid intake starting the night prior to the procedure and have no fluids for 4 hours before. This is so you will be able to hold your urine in during the procedure for the full treatment time. In addition, the area receives more concentrated (and effective) doses of the drug with less urine output during the procedure.
  • If you take a diuretic (water pill), you will be told to not take this for at least 4 hours before the procedure.
  • A urinary catheter is inserted into the bladder and any urine is drained.
  • The medication is given through the catheter, into the bladder. The catheter may be removed or clamped and remain in place based on your provider’s recommendation.
  • You will need to hold the medication in your bladder for 1 hour. You may need to change positions every 15 minutes to be sure the drug reaches all areas of the bladder.
  • After 1 hour, the medication will be drained from your bladder. Any medication or urine voided into the toilet should be disinfected for 30 minutes before flushing the toilet. This can be done by putting bleach in the toilet before use.

Precautions After Treatment

  • Before you urinate after treatment has been completed, add about a half cup of bleach to the toilet bowl. After you urinate, wait 15 minutes before flushing the toilet. Repeat these steps every time you urinate for the first 2 days after treatment. This is to protect yourself and others from any medication that may be in your urine.
  • You should sit to urinate for 6 hours after the treatment to prevent splashing urine on the skin or exposing others to the medication.
  • Do not use public toilets or urinate outside.
  • Wash your hands and genital area with soap and water after urinating to remove any traces of the medication from your skin and prevent skin irritation.
  • Drink plenty of fluids for 8-12 hours after your treatment to flush your bladder.
  • Prevent others from being exposed to the medication by washing your clothes separately from the rest of the laundry and wearing rubber gloves when cleaning the toilet or any urine spills.
  • If using an incontinence pad, place it in a plastic bag and discard it with trash.

Possible Side Effects of Nadofaragene Firadenovec-vncg

  • Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
  • If you notice any discharge at the site where the medication goes into your body, let your provider know right away.
  • Some patients will develop a bladder infection after this procedure. If you have an urgency to urinate, bladder spasms, discharge, burning or pain with urination, blood in the urine, or fever, notify your healthcare team right away. These may be related to an infection or a side effect of the medication.
  • This medication can cause elevated blood sugar levels in patients with and without diabetes. Your oncology care team will monitor your blood sugar. Signs of high blood sugar are increased thirst, urination or hunger, blurry vision, headaches or your breath smells like fruit. If you have any of these symptoms you should notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.
  • This medication can cause an increase in your cholesterol levels. Your healthcare team will monitor your cholesterol levels throughout your treatment.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Even if your menstrual cycle stops or you believe you are not producing sperm, effective birth control is necessary during treatment and for 6 months after treatment for women and 3 months after treatment for men. You should not breastfeed while taking this medication.