Streptozocin (Specialist drug)

How it works

It is an alkylating agent that causes DNA damage, with relative selectivity for pancreatic islet cells, leading to tumour-cell death.

Prescribing in practice

• Nephrotoxicity is dose-limiting and can be severe, so renal function must be assessed before each course and the drug withheld if function deteriorates.
• It is highly emetogenic and requires effective antiemetic prophylaxis.
• Given by intravenous infusion under specialist oncology supervision with attention to extravasation and hepatic toxicity.

Monitoring

Monitor renal function (including urinary protein), liver function and full blood count before and during each treatment cycle.

Counselling the patient

• Report reduced urine output, swelling, or unusual tiredness, which may indicate kidney effects.
• Maintain good hydration as advised by your team.
• Expect anti-sickness medicines to be given alongside treatment and report nausea or vomiting that is not controlled.

Evidence & guidelines

Its role in advanced pancreatic neuroendocrine tumours is long established in oncology practice and guidelines.