streptozocin: clinical use

Prescribing considerations

• Administration requires an experienced systemic anticancer therapy team with laboratory and supportive-care facilities.
• Provide antiemetic prophylaxis and appropriate intravenous hydration.
• Assess benefit and risk carefully in pre-existing renal disease, hepatic impairment and older adults.
• Safety and efficacy have not been established in people younger than 18 years.
• Discuss contraception and fertility preservation before treatment where relevant.

Contraindications and cautions

• Hypersensitivity to streptozocin or an excipient
• Renal failure with glomerular filtration rate below 30 mL/min
• Concurrent live or live-attenuated vaccines
• Breastfeeding

Monitoring

• Renal function, including creatinine and estimated GFR
• Urinary protein and serum electrolytes
• Full blood count
• Liver function
• Blood glucose
• Clinical toxicity and infusion-site integrity
• Tumour response using imaging and, for functional tumours, relevant biological markers

Clinical pharmacology

Streptozocin is a nitrosourea alkylating antineoplastic agent. Reactive metabolites methylate and cross-link DNA, causing apoptosis or necrosis. The parent compound clears rapidly from plasma; nitrosourea-containing metabolites persist longer and are substantially eliminated in urine.

Formulation and product differences

• Freeze-dried powder for concentrate for intravenous infusion.
• Requires aseptic reconstitution and dilution by trained staff.
• Single-use, preservative-free presentation containing citric acid, sodium hydroxide and sodium.

Solution for infusion

Route: Intravenous

Strengths: 1 g