Chad Reichard, MD, on re-induction with nadofaragene in NMIBC

In an interview at the 2026 American Urological Association Annual Meeting, Chad A. Reichard, MD, highlighted new real-world findings evaluating re-induction with nadofaragene firadenovec-vncg (Adstiladrin) in patients with BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC). Reichard is a urological oncologist, director of cancer services, and co-director of clinical research at Urology of Indiana in Indianapolis.

Nadofaragene is 1 of the FDA-approved bladder-sparing options for patients with BCG-unresponsive disease. The intravesical gene therapy is administered every 3 months in patients maintaining a complete response (CR). However, patients in the pivotal phase 2 and 3 studies who failed to achieve a CR after the first dose were classified as treatment failures and did not receive additional therapy. Reichard noted that clinicians have increasingly questioned whether a re-induction strategy, similar to approaches used with BCG and other intravesical therapies, could benefit initial non-responders in real-world practice.

Thus, Reichard and his colleagues conducted a retrospective study that drew on de-identified electronic health record data of US private urology practices in the US. Eligible patients had carcinoma in situ (CIS) with or without papillary disease (Ta or T1), failed to achieve CR after an initial dose of nadofaragene firadenovec, subsequently received at least 1 additional re-induction dose, and had follow-up cystoscopy data available. Thirteen patients met inclusion criteria, including 8 with CIS alone, 2 with CIS plus Ta disease, and 3 with CIS plus T1 disease. Patients had a mean age of 77.5 years and had received a mean of 11 prior BCG doses; several had also been treated with prior gemcitabine or pembrolizumab (Keytruda). The median follow-up was 379 days (range, 135 to 519).

Data showed that 4 of the 13 patients (30.8%) achieved a CR after re-induction, including 2 patients with CIS plus T1 disease. Response patterns varied, with some patients experiencing durable responses across multiple doses while others demonstrated early persistence or recurrence. One patient ultimately progressed to muscle-invasive T2a disease and underwent cystectomy, but no deaths were reported during follow-up. Reichard also noted that among patients who failed to respond to the second induction attempt, additional re-induction dosing did not subsequently produce CRs.

Overall, he said the findings suggest that re-induction with nadofaragene firadenovec may represent a feasible salvage strategy for select patients with BCG-unresponsive NMIBC, although larger studies with longer follow-up will be needed to better define its role in clinical practice.

REFERENCE

1. Reichard C, Trainer A, Grant K, et al. A REAL-WORLD CASE SERIES OF RE-INDUCTION WITH NADOFARAGENE FIRADENOVEC IN PATIENTS WITH CARCINOMA IN SITU ± PAPILLARY NON–MUSCLE-INVASIVE BLADDER CANCER. Presented at: 2026 American Urological Association. Washington, DC. May 15-18, 2026. doi:10.1097/01.JU.0001191584.85292.ee.21