Classifications: antineoplastic; alkylating agent; Therapeutic: antineoplastic
Pregnancy Category: D
1 g injection
Streptozocin is highly toxic and has a low therapeutic index; thus a clinically effective response is likely to be accompanied
by some evidence of toxicity. Inhibits DNA synthesis in cells and prevents progression of cells into mitosis, affecting all
phases of the cell cycle (cell-cycle nonspecific). Appears to have minimal effects on RNA or protein synthesis.
Successful therapy with streptozocin (alone or in combination) produces a biochemical response evidenced by decreased secretion
of hormones as well as measurable tumor regression. Thus, serial fasting insulin levels during treatment indicate response
to this drug.
Metastatic functional and nonfunctional islet cell carcinoma of pancreas, as single agent or in combination with fluorouracil.
A variety of other malignant neoplasms including metastatic carcinoid tumor or carcinoid syndrome, refractory advanced Hodgkin's
disease, and metastatic colorectal cancer.
Pregnancy (category D), lactation. Safety in children is not established.
Renal impairment; hepatic disease, hepatic impairment; patients with history of hypoglycemia; diabetes mellitus.
Route & Dosage
|Islet Cell Carcinoma of Pancreas
Adult: IV 500 mg/m2/d for 5 consecutive days q6wk or 1 g/m2/wk for 2 wk, then increase to 1.5 g/m2/wk, infuse dose over 15 min to 6 h
If Clcr 1050 mL/min, use 75% of dose; if less, use 50% of dose.
- Use only under constant supervision by physician experienced in therapy with cytotoxic agents and only when the benefit
to risk ratio is fully and thoroughly understood by patient and family.
- Wear gloves to protect against topical exposure, which may pose a carcinogen hazard, when handling streptozocin. If solution
or powder comes in contact with skin or mucosa, promptly flush the area thoroughly with soap and water.
PREPARE: IV Infusion: Reconstitute with 9.5 mL D5W or NS, to yield 100 mg/mL. Solution will be pale gold. May be further diluted with up to 250
mL of the original diluent. Protect reconstituted solution and vials of drug from light.
ADMINISTER: IV Infusion: Give over 1560 min. Inspect injection site frequently for signs of extravasation (patient complaints of stinging or
burning at site, swelling around site, no blood return or questionable blood return). If extravasation occurs, area requires
immediate attention to prevent necrosis. Remove needle, apply ice, and contact physician regarding further treatment to
INCOMPATIBILITIES Y-site: Allopurinol, aztreonam, cefepime, piperacillin/tazobactam.
- Note: An antiemetic given routinely every 4 or 6 h and prophylactically 30 min before a treatment may provide sufficient control
to maintain the treatment regimen (even if it reduces but not completely eliminates nausea and vomiting).
- Discard reconstituted solutions after 12 h (contains no preservative and not intended for multidose use).
Adverse Effects (≥1%)CNS:
Confusion, lethargy, depression
. GI: Nausea, vomiting, diarrhea
, transient increase in AST, ALT, or alkaline phosphatase
; hypoalbuminemia. Hematologic: Mild
to moderate myelosuppression (leukopenia, thrombocytopenia, anemia). Metabolic:
Glucose tolerance abnormalities (moderate and reversible); glycosuria without hyperglycemia, insulin shock
(rare). Urogenital: Nephrotoxicity: azotemia, anuria, proteinuria, hypophosphatemia, hyperchloremia
; Fanconi-like syndrome
tubular reabsorption defects, alkaline pH of urine, glucosuria, acetonuria, aminoaciduria): Hypokalemia,
Local necrosis following extravasation.
InteractionsDrug: myelosuppressive agents
add to hematologic toxicity
agents (e.g., aminoglycosides
, vancomycin, amphotericin B, cisplatin
) increase risk of nephrotoxicity; phenytoin
may reduce cytotoxic
effect on pancreatic beta cells.
Undetectable in plasma
within 3 h. Distribution: Metabolite
enters CSF. Metabolism:
In liver and kidneys. Elimination:
7080% of dose in urine, 1% in feces, and 5% in expired air. Half-Life:
Assessment & Drug Effects
- Lab tests: Perform CBC at least weekly, and liver function tests prior to each course of therapy. Dosage adjustment or discontinuation
may be required if there is evidence of decreased liver or bone marrow function. Obtain serial urinalyses and determinations
of BUN, creatinine clearance, and serum electrolytes prior to and weekly during therapy, then for 4 wk after termination
- Ensure that repeat courses of streptozocin treatment are not given until patient's liver, kidney, and hematologic functions
are within acceptable limits. Platelet and leukocyte nadirs generally occur 12 wk after beginning therapy.
- Report evidence of drug-induced declining kidney function promptly; changes are dose related and cumulative.
- Be alert to early laboratory evidence of kidney dysfunction: Hypophosphatemia, mild proteinuria, and changes in I&O ratio
- Mild adverse renal effects may be reversible following discontinuation of streptozocin, but nephrotoxicity may be irreversible,
severe, or fatal.
- Be alert to symptoms of sepsis and superinfections (leukopenia) or increased tendency to bleed (thrombocytopenia). Myelosuppression
is severe in 1020% of patients and may be cumulative and more severe if patient has had prior exposure to radiation
or to other antineoplastics.
- Monitor for S&S of superinfection (see Appendix F).
- Monitor and record temperature pattern to promptly recognize impending sepsis.
Patient & Family Education
- Inspect site at weekly intervals and report changes in tissue appearance if extravasation occurred during IV infusion.
- Report symptoms of hypoglycemia (see Appendix F) even though this drug has minimal, if any, diabetogenic action.
- Drink fluids liberally (20003000 mL/d). Hydration may protect against drug toxicity effects.
- Report S&S of nephrotoxicity (see Appendix F).
- Do not take aspirin without consulting physician.
- Report to physician promptly any signs of bleeding: Hematuria, epistaxis, ecchymoses, petechial.
- Report symptoms that suggest anemia: Shortness of breath, pale mucous membranes and nail beds, exhaustion, rapid pulse.