Generic Name: Streptozocin (STREP-the-ZOE-sin)
Trade Name: Zanosar®
How is Zanosar® used? Zanosar is FDA approved for the treatment of islet cell cancer of the pancreas. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.
What is the mechanism of action? Zanosar is classified as an alkylating agent. An alkylating agent produces its anti-cancer effects by causing a chemical reaction that damages the DNA in a cell. The DNA damage caused by Zanosar results in cell death.
How is Zanosar given (administered)? Zanosar is administered into a vein (intravenous) and the dose depends on several factors, including the condition being treated, the size of the patient, the particular treatment regimen being used, and the overall health of the patient. If Zanosar escapes from the vein in which it is administered it may cause serious damage to the tissue that it comes in contact with. Although patients will be monitored for this, they should tell their healthcare provider immediately if they experience pain, redness or swelling at the site in which the drug is being administered.
How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with Zanosar. Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the liver. Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.
Patients will be closely monitored for kidney function, with tests often done prior to and following each dose of Zanosar, as it is associated with serious side effects to the kidney. Kidney toxicity is dose-related and cumulative and may be severe or fatal.
Patients will also have their blood sugar monitored, as Zanosar may affect levels of sugar in the blood. Zanosar may also cause reduced levels of blood cells, a potentially serious yet uncommon side effect. Therefore patients will be monitored for any type of infection associated with low white blood cell levels, persistent fatigue associated with low red blood cell levels, and unexplained or pronounced bleeding associated with low platelet levels.
What are the common (occur in 30% or more of patients) side effects of treatment with Zanosar?
- Nausea and vomiting
- Decreased kidney function, kidney damage
What are the less common (occur in 10% to 29% of patients) side effects of treatment with Zanosar?
- Changes in liver function tests, liver damage
- Abnormalities in blood sugar levels
- Injection site reactions (pain, burning)
This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.
Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.
What are the possible late side effects of treatment with Zanosar?
Understanding DNA Damage Response or DDR and Cancer Treatment
What is DNA Damage Response or DDR?
Patients treated with Zanosar are at a slightly increased risk of developing a secondary malignancy. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy. Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.
What can patients do to help alleviate or prevent discomfort and side effects?
- Pay careful attention to the physician’s instructions and inform the physician of any side effects.
- Maintain adequate rest and nutrition.
- Wear sunscreen and protective clothing and try to minimize sun exposure.
- Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
- Eat small meals frequently to help alleviate nausea.
- If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
Are there any special precautions patients should be aware of before starting treatment?
- Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
- It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
- Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
- Patients should check with their physician before starting any new drug or nutritional supplement.
- Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
- Patients who are diabetic should monitor blood sugar carefully.
- Patients should use caution when driving or completing tasks that require mental alertness until effects of the drug are known
When should patients notify their physician?
- Swelling of the feet or ankles
- Decrease in frequency or amount of urine
- Sudden weight gain
- Yellowing of the skin or eyes
- Right upper quadrant pain
- Dizziness, lightheadedness
- Fever, chills, aches
- Sore throat
- Signs of infection such as redness, swelling, pus
- Persistent or severe fatigue
- Unexplained or pronounced bleeding (nosebleed, bruising, blood in the urine, black tarry stools, etc.)
- Symptoms of low blood sugar (chills, fast heartbeat, headache, unusual drowsiness or weakness)
- Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers. A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. By carefully reviewing the package insert, you will get the most complete and current information about how to safely use this drug. If you do not have the package insert for the drug you are using, your pharmacist or physician may be able to provide you with a copy.
Important Limitations of Use
The information provided above on the drug you have selected is provided for your information only and is not a substitute for consultation with an appropriate medical doctor. We are providing this information solely as a courtesy and, as such, it is in no way a recommendation as to the safety, efficacy or appropriateness of any particular drug, regimen, dosing schedule for any particular cancer, condition or patient nor is it in any way to be considered medical advice. Patients should discuss the appropriateness of a particular drug or chemotherapy regimen with their physician.
As with any printed reference, the use of particular drugs, regimens and drug dosages may become out-of-date over time, since new information may have been published and become generally accepted after the latest update to this printed information. Please keep in mind that health care professionals are fully responsible for practicing within current standards, avoiding use of outdated regimens, employing good clinical judgment in selecting drugs and/or regimens, in calculating doses for individual patients, and verifying all dosage calculations.
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The prescribing physician is solely responsible for making all decisions relating to appropriate patient care including, but not limited to, drugs, regimens, dose, schedule, and any supportive care.