Streptozocin (Zanosar)

Streptozocin is a chemotherapy drug used to treat pancreatic cancer and carcinoid tumour. It is not licensed in the UK but is used in research trials. It belongs to a group of chemotherapy drugs called nitrosoureas. They work by sticking to one of the cancer cell's DNA strands so the cell can't divide into 2 new cells.

Streptozocin is a clear liquid that you have by injection through a fine tube (cannula) put into a vein (intravenously). Or you may have it through a central line, a portacath or a PICC line. These are thin tubes that go into a vein near your collarbone. They are put in before the treatment starts and stay in as long as you need them.

You normally have chemotherapy as a course of several cycles of treatment. You usually have streptozocin for 5 days every 6 weeks. Or you may have it weekly for 6 weeks. The treatment plan depends on which type of cancer you have. There is more about how doctors plan chemotherapy in CancerHelp UK.

Some people can't have streptozocin. Your doctor is not likely to recommend it if you are not well enough to spend more than half the day up and about. Or if you have significant kidney or liver problems.

The side effects associated with streptozocin are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of these.

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Feeling or being sick occurs in 9 out of 10 people (90%) and is most likely to start within 2 to 4 hours of having treatment – it lasts for a few hours but is usually controlled with anti sickness injections and tablets
• Kidney problems happen to about half the people treated and you may notice a drop in your urine output or swelling in your ankles and feet – you will have blood tests before each treatment to check your kidney function. Permanent kidney damage is rare
• Changes in liver function – you will have regular blood tests to see how well your liver is working but everything should go back to normal once your treatment is over
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug so talk to your doctor before starting treatment if having a baby is important to you
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Streptozocin may have a harmful effect on a developing baby and it is not advisable to become pregnant or father a child if you are having this drug – talk about contraception with your doctor or nurse before having the treatment
• You should not breastfeed while having this drug as it may come through in the breast milk

Between 1 and 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other occasional side effects include

• Changes to sugar levels in your blood – your doctor will check this with regular blood tests. If you are diabetic, you will have to take extra care in checking your blood sugar. Low blood sugar may cause weakness, sweating, headaches and confusion. High blood sugar may cause thirst, hunger and passing more urine than normal.
• A sore mouth or mouth ulcers
• Diarrhoea is usually controlled with medicine from your doctor or nurse
• While you are having the chemotherapy, stretozocin may leak from the drip or injection site and damage the body tissues in that area. It is important to tell the nurse or doctor if you have any stinging or burning around the site, leaking fluid, redness or swelling around the site after treatment is finished

Rarely, another cancer can develop many years after streptozocin treatment.

Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.