Vikram Narayan, MD, on weighing treatment options in NMIBC

In this video, Vikram M. Narayan, MD, highlights the challenges and opportunities associated with the array of new treatment options in bladder cancer, specifically focusing on nadofaragene firadenovec-vncg (Adstiladrin). Nadofaragene was approved in December 2022 for the treatment of patients with high-risk BCG-unresponsive non–muscle invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors. Narayan is an assistant professor of urology at Emory University and the director of urological oncology at Grady Memorial Hospital in Atlanta, Georgia.

Video Transcript:

In my practice, I provide patients with a menu of treatment options. When a patient comes in with BCG unresponsive, obviously we talk about cystectomy, we talk about nadofaragene, there's also nogapendekin alfa inbakicept-pmln or Anktiva together with BCG as an option, gemcitabine/docetaxel, which of course, is being used off label, but widely used and considered very effective. There's some trials underway that we're interested in seeing the results for, including the BRIDGE study. I think that you have to present the pros and cons of each treatment option to the patient. I do enroll a lot of patients in clinical trials as well.

As it relates to challenges. I think challenges that patients face include things like having to decide between the menu of options. It's a good problem to have, because we're thinking about a previous era in which we didn't have many options besides more BCG vs cystectomy, and now patients have the ability to choose from options. But I think it's fair to say that we haven't been as excited about the durability of a lot of these agents. We want to see better durability.

As far as convenience for the patient, the things that I talk about are cost, how easy it is to get it, what are the adverse events for these drugs. Nadofaragene tends to be relatively well tolerated. There are some issues that people can have as it relates to bladder spasm, things of that sort, which in my practice, we manage by giving patients anticholinergics prior to treatment. That seems to work relatively well for them. Another challenge, of course, is storage and handling. This drug does arrive frozen. It does need to be thawed. The company has provided some additional guidance on how to make that piece easier, but I think in a lot of urology practices, being able to do that in an efficient way in a busy clinical practice remains a challenge.

The other thing that is convenient for the patient with this is that you can dose it once every 3 months as opposed to once a week like a lot of the other treatments that are available. But I let my patients choose after presenting the pros and cons of each of the options for them.

This transcript was AI generated and edited by human editors for clarity.