Streptozocin (Zanosar®)

Streptozocin kills cancer cells through a process called alkylation. Alkylation damages the DNA of cells, which prevents them from dividing and causes them to die. Since cancer cells divide faster than healthy cells, cancer cells are more sensitive to this damage.

How to Take Streptozocin

Streptozocin is given by intravenous (IV, into a vein) infusion. The dose and schedule are based on your body size and type of cancer. Your provider will figure out the best schedule for your treatment.

Even when carefully and correctly administered by trained personnel, this drug may cause a feeling of burning and pain. There is a risk that this medication may leak out of the vein at the injection site, causing tissue damage that can be severe. If the area of injection becomes red, swollen, or painful at any time during or after the injection, tell your care team right away. Do not apply anything to the site unless told to do so by your care team.

Possible Side Effects of Streptozocin

There are a number of things you can do to manage the side effects of streptozocin. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Kidney Toxicity

This medication can cause kidney problems, including kidney failure, which your care team may monitor for using blood and urine tests. Tell your provider right away if you notice decreased urine output, blood in your urine, swelling in the ankles, or loss of appetite.

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole-grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Liver Toxicity

This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Blood Counts

Your blood counts can be affected by this treatment, though the effect is usually mild. This can cause lower numbers of the following cells:

• White blood cells (WBC): Important for fighting infection. Tell your provider right away if you have a fever (temperature greater than 100.4 or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
• Red blood cells: Help carry oxygen to the tissues in your body. Tell your care team if you have any shortness of breath. Call 911 if you have a hard time breathing or have pain in your chest. If the count gets too low, you may receive a blood transfusion.
• Platelets: Help your blood clot, so when the count is low, you are at a higher risk of bleeding. Tell your care team if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool.

Important but Less Common Side Effects

• Low Blood Sugar (Hypoglycemia): This medication can cause low blood sugar levels in patients with and without diabetes. Your oncology care team will monitor your blood sugar. Contact your care team if you experience pale skin, shakiness, sweating, hunger, or irritability as these can be symptoms of low blood sugar. Diabetics should monitor their blood sugar closely.
• Confusion & Lethargy: Until you know how this medication will affect you, exercise caution when driving or operating machinery.

Reproductive Concerns

This medication may affect your reproductive system, resulting in the menstrual cycle or sperm production becoming irregular or stopping permanently. Women may experience menopausal effects including hot flashes and vaginal dryness. In addition, the desire for sex may decrease during treatment. You may want to consider sperm banking or egg harvesting if you may wish to have a child in the future. Discuss these options with your oncology team.

Exposure of the fetus to this medication could cause birth defects, so you should not become pregnant or father a child while receiving this medication. It is necessary to use an effective method of contraception during treatment. Even if your menstrual cycle stops or you think you are not making sperm, you could still be fertile and conceive. You should not breastfeed while taking this medicine.