Adult Dosing
Metastatic islet cell carcinoma of pancreas
- 500 mg/m2 IV qd x 5 days q6 wks until therapeutic effect or treatment-limiting toxicity is seen
- Alt: 1000 mg/m2 qwk x 2 wks; may titrate the dose in subsequent courses in patients who did not exhibit a therapeutic response and who did not experience significant toxicity with the previous course of treatment
- Max: 1500 mg/m2 per dose
Notes:- Reconstitute with 9.5 mL of dextrose or 0.9% NaCl injection; use within 12 hrs of reconstitution
- Use gloves while handling and preparation of streptozocin powder. If there is contact with the skin or mucosa, wash the affected area immediately with soap and water
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- CrCl 10-50 mL/minute: 75% of the usual dose
- CrCl <10 mL/minute: 50% of the usual dose
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
See Supplemental Patient Information
- Streptozocin should be administered under the supervision of physicians experienced in cancer chemotherapy [US Black Box Warning]
- Hospitalization is not necessary, but the patient should have access to a medical facility with laboratory and supportive resources necessary to monitor drug tolerance and manage a patient developing drug toxicity [US Black Box Warning]
- Before prescribing streptozocin, the physician should weigh the potential benefits to the patient against the known toxic effects of the drug [US Black Box Warning]
- Renal toxicity, manifested as azotemia, anuria, hypophosphatemia, glycosuria, and renal tubular acidosis, has been reported in patients treated with streptozocin. Such toxicity is dose-related and cumulative and may be fatal
- Serial urinalysis, blood urea nitrogen, plasma creatinine, serum electrolytes, and creatinine clearance should be obtained prior to, at least weekly during, and for 4 weeks after drug administration. In case of severe renal toxicity, reduce the dose or discontinue the drug if necessary
- Renal functions should be monitored before and after each course of therapy
- Liver function tests and CBC should be done regularly (at least weekly) during therapy. Dose adjustments or discontinuation of therapy may be recommended based on the level of toxicity
- Streptozocin is mutagenic; it has been found to be tumorigenic or carcinogenic in rodents following parenteral administration [US Black Box Warning]
- Streptozocin powder is irritating to tissues; extravasation may lead to severe tissue lesions and necrosis
- Additive toxicity may occur when co-administered with other cytotoxic drugs
- Patients should be informed about the potential risk in driving or using complex machinery
- Confusion, lethargy, and depression have been reported in certain patients receiving continuous IV infusion for 5 days
Cautions: Use cautiously in
- Preexisting renal disease
- Hepatic impairment
- Myelosuppression
- Elderly patients
Supplemental Patient Information
- Advise patients to avoid performing activities such as driving or operating heavy machinery during treatment
Pregnancy Category:D
Breastfeeding: Unsafe. Manufacturer recommends discontinuation of nursing due to the potential for serious adverse effects in breastfed infants.
