Nogapendekin alfa inbakicept-pmln (Anktiva®)
Pronounce: noe-GAP-en-DE-kin AL-fa in-BAK-i-sept
Classification: Biologic Response Modifier, Interleukin-15 (IL-15) receptor agonist
About Nogapendekin alfa inbakicept-pmln (Anktiva®)
This medication is a biologic response modifier targeting IL-15. Biological response modifiers are substances that have no direct antitumor effect, but can trigger the immune system to attack tumors. This medication is used with Bacillus Calmette-Guérin (BCG), another biologic response modifier, to treat some cancers. When used together, the immune system is activated, causing inflammation of the bladder wall that then destroys cancer cells within the bladder.
How to Take This Medication
This medication is given directly into the bladder (called intravesically) through a catheter. The medicine is left in the bladder for 2 hours; if you are not able to retain it for that long, it can be voided sooner. The dosage and schedule are determined by your healthcare provider. You may have red-tinged urine the first 24 hours after administration.
How the Intravesicular Treatment is Given
- Limit how much you drink 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 medicine with less urine output during the procedure.
- If you take a diuretic (water pill), do not take it 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 stay in place based on your provider’s recommendation.
- You will hold the medication in your bladder for 2 hours. You may need to change positions every 15 minutes to be sure the medicine reaches all areas of the bladder. Do this by rolling on your side, back, other side, and stomach.
Precautions After Treatment
- Try not to urinate for 1-2 hours after the procedure.
- 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.
- For the first six hours after treatment, each time after you urinate:
- Add 2 cups of household bleach to the toilet bowl and close the lid.
- Wait 15-20 minutes and then flush the toilet with the lid down.
- 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, starting after the first time you urinate and for 8-12 hours after your treatment to flush your bladder.
- If you have urine incontinence, immediately wash your clothes in the washer. Do not wash with other clothes.
- After using an incontinence pad, pour bleach on the pad, allow it to soak in, place it in a plastic bag, and discard it with the trash.
- Call your provider if you develop a fever (greater than 101.3° F/38.5°C) or shaking chills.
Possible Side Effects
These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.
Bladder and Urinary Problems
You may have pain urinating (dysuria), frequent urination, urgency to urinate, blood in urine (hematuria), and urinary tract infection. Symptoms of urinary tract infection include frequency, urgency, and burning with urination. It is less common, but this medication can also cause bladder irritation and frequent overnight urination (nocturia). These side effects can also affect your lab values, like creatinine. You will have your labs drawn to monitor these values. If you’re having any of these symptoms, contact your provider right away.
Reproductive Concerns
There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.
If you can become pregnant, you will need to use effective birth control during treatment and for 1 week after the last dose of this medication, even if your menstrual cycle has stopped or changed. If you can get someone pregnant, you will need to use effective birth control during treatment and for 1 week after the last dose of this medication, even if you believe you are not producing sperm. Talk with your provider about breastfeeding while receiving or after having this medication.