Streptozocin (Zanosar ®)
Streptozocin (Zanosar ®) is a chemotherapy drug used to treat pancreatic cancer and some neuroendocrine tumours (NETs). It may be used along with other chemotherapy drugs.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
How streptozocin is given
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You will usually have streptozocin in the chemotherapy day unit. A chemotherapy nurse will give it to you. During treatment, you will usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of the treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs and sometimes a steroid as an injection into a vein.
Your treatment will be given in one of the following ways:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you streptozocin as a drip (infusion) into your cannula or line over about an hour. They will usually run the drip through a pump, which gives you the treatment over a set time.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Streptozocin may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Pain along the vein
If you have pain along the vein where your treatment is being given, tell your nurse straight away. They will check your drip site and slow the drip to ease the pain.
The drug leaks outside the vein
If this happens when you’re having streptozocin it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens, it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Your course of streptozocin
You will have streptozocin chemotherapy as a course of several sessions (or cycles) of treatment over a few months. The number of cycles will depend on the type of cancer you have. Your doctor or nurse will tell you more about this and the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs. Take all your tablets exactly as your nurse or pharmacist has explained.
Possible side effects of streptozocin
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We explain the most common side effects of streptozocin here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection - this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Rarely, streptozocin can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells that carry oxygen around the body. But this isn’t common with streptozocin.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. They may also give you a steroid drug to help. Take the drugs exactly as your nurse or pharmacist explains. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick, or vomit twice or more in 24 hours, contact the hospital on the numbers they gave you as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you. Some people may need to go to hospital for a short time so the doctors and nurses can control their sickness. Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Raised or reduced blood sugar levels
Streptozocin may change your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. They can show you how to do this at home.
Symptoms of a raised blood sugar level are feeling thirsty, needing to pass urine more often and feeling tired. Tell your doctor or nurse if you have these symptoms. Symptoms of a low blood sugar level are feeling dizzy, sweating and feeling confused. If you have these symptoms, have a sugary drink and contact the hospital on the number you’ve been given.
If you have diabetes, you may need to check your blood sugar levels more often. Your doctor will talk to you about how to manage this. You may need to adjust your dose of insulin or diabetes tablets.
You will probably feel very tired and need a lot of rest. Try to balance this with some gentle exercise, such as short walks, which will help. You’ll probably tire easily for some months after your treatment, but this will gradually get better.
Streptozocin may cause changes in the way your kidneys works, although this will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your kidneys are working properly.
Your urine will also be checked every week for a build-up of protein. It will also be checked for four weeks after you finish your treatment.
Streptozocin may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Effects on the nervous system
Streptozocin can affect the nervous system and cause mood changes, such as confusion. If you notice that you’re feeling confused, don’t drive or operate machinery. Talk to your nurse or doctor and they can advise you about what might help.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about streptozocin
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Blood clot risk
Cancer increases the chances of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Streptozocin can affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed September 2013).
British National Formulary. 65th edition. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2013.
Truven Health Analytics Inc. Micromedex 2.0 ®. 2013. micromedexsolutions.com (accessed September 2013).
Keocyt SAS. Zanosar. 2011. zanosar.com (accessed September 2013).
With thanks to Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice, who reviewed this edition.
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