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MITOMYCIN SOLN,URH

Clinical Criteria Summary

Exclusion Criteria

  • Perforation of the bladder or upper urinary tract
  • Contraindication or known sensitivity to mitomycin
  • Glomerular Filtration Rate of <30 mL/minute
  • Pregnancy (i.e. known pregnancy or positive pregnancy test)
  • Breastfeeding
  • CBC at baseline (i.e. WBC ≥3 X109/L, ANC ≥1.5 x 109/L, Platelets ≥100,000 x 109/L, Hgb ≥9.0 mg/dL)

Inclusion Criteria

  • Care is provided by a VA/VA Community Care urology or oncology provider
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Goals of care and role of Palliative Care consult have been discussed and documented
  • Patients of child-bearing potential and patients with partners of child-bearing potential: counseling provided on contraception and risks vs. benefits of treatment; effective contraception used during therapy and for 6 months after the last dose (patients) or 3 months after the last dose (partners)

Additional Inclusion Criteria

  • Treatment naïve, residual disease, or recurrent low-grade Upper Tract Urothelial Carcinoma: treat weekly for 6 weeks
  • Monthly maintenance therapy (for 1 year) after complete response can be considered on a case-by-case basis (data on monthly maintenance therapy is not robust)

Source Documents