Anti-neoplastic drugs

Anti-neoplastic drugs US Medical PG Question 1: A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

• A. Level 1
• B. Level 3 (Correct Answer)
• C. Level 5
• D. Level 4
• E. Level 2

Anti-neoplastic drugs Explanation: ***Level 3*** - A **non-randomized controlled trial** like the one described, where patient assignment to treatment groups is based on specific characteristics (risk of toxicity), falls into Level 3 evidence. - This level typically includes **non-randomized controlled trials** and **well-designed cohort studies** with comparison groups, which are prone to selection bias and confounding. - The study compares two treatments but lacks randomization, making it Level 3 evidence. *Level 1* - Level 1 evidence is the **highest level of evidence**, derived from **systematic reviews and meta-analyses** of multiple well-designed randomized controlled trials or large, high-quality randomized controlled trials. - The described study is explicitly stated as non-randomized, ruling out Level 1. *Level 2* - Level 2 evidence involves at least one **well-designed randomized controlled trial** (RCT) or **systematic reviews** of randomized trials. - The current study is *non-randomized*, which means it cannot be classified as Level 2 evidence, as randomization is a key criterion for this level. *Level 4* - Level 4 evidence includes **case series**, **case-control studies**, and **poorly designed cohort or case-control studies**. - While the study is non-randomized, it is a controlled comparative trial rather than a case series or retrospective case-control study, placing it at Level 3. *Level 5* - Level 5 evidence is the **lowest level of evidence**, typically consisting of **expert opinion** without explicit critical appraisal, or based on physiology, bench research, or animal studies. - While the drug was initially tested in animal studies, the current human comparative study offers a higher level of evidence than expert opinion or preclinical data.

Anti-neoplastic drugs US Medical PG Question 2: A 55-year-old Caucasian male presents for a routine colonoscopy. A polyp is found in the patient's transverse colon and is found to be cancerous on histological evaluation. Upon examination, it is found that these cancerous cells have decreased MHC class I expression on their surface. Which immune system cell is most capable of killing these tumor cells?

• A. Cytotoxic T-cells
• B. B-cells
• C. Macrophages
• D. Natural killer cells (Correct Answer)
• E. Eosinophils

Anti-neoplastic drugs Explanation: ***Natural killer cells*** - **Natural killer (NK) cells** are specialized lymphocytes that identify and kill cells with **decreased or absent MHC class I expression**, a common feature of tumor cells and virus-infected cells. - They provide a rapid, non-specific immune response without prior sensitization. *Cytotoxic T-cells* - **Cytotoxic T-cells (CTLs)** recognize and kill target cells by binding to specific **antigens presented by MHC class I molecules**. - Since these cancer cells have **decreased MHC class I expression**, CTLs would be less effective at recognizing and killing them. *B-cells* - **B-cells** are primarily involved in humoral immunity, producing **antibodies** that can neutralize pathogens or mark cells for destruction. - They do not directly kill target cells, and their activation typically requires specific antigen recognition, often with T-cell help. *Macrophages* - **Macrophages** are phagocytic cells that engulf and digest cellular debris, pathogens, and some tumor cells. - While they can kill tumor cells, their primary mechanism involves **phagocytosis** or antigen presentation, not direct cytotoxicity based on MHC I expression levels. *Eosinophils* - **Eosinophils** are granulocytes primarily involved in the defense against **parasitic infections** and in allergic reactions. - They are not a primary defense mechanism against tumor cells, especially not based on MHC class I expression.

Anti-neoplastic drugs US Medical PG Question 3: A 60-year-old female presents to her gynecologist with bloating, abdominal discomfort, and fatigue. She has a history of hypertension and takes hydrochlorothiazide. Physical exam reveals ascites and right adnexal tenderness. Initial imaging reveals a mass in the right ovary and eventual biopsy of the mass reveals ovarian serous cystadenocarcinoma. She is started on a chemotherapeutic agent with plans for surgical resection. Soon after starting the medication, she develops dysuria and hematuria. Laboratory analysis of her urine is notable for the presence of a cytotoxic metabolite. Which of the following mechanisms of action is consistent with the medication in question?

• A. Folate analog
• B. Microtubule inhibitor
• C. DNA alkylating agent (Correct Answer)
• D. Platinum-based DNA cross-linking agent
• E. BRAF inhibitor

Anti-neoplastic drugs Explanation: ***DNA alkylating agent*** - Cyclophosphamide is a **DNA alkylating agent** commonly used in the treatment of ovarian cancer. It is metabolized to **acrolein**, a cytotoxic metabolite that causes **hemorrhagic cystitis**, presenting as dysuria and hematuria. - DNA alkylating agents exert their cytotoxic effects by forming **covalent bonds** with DNA, leading to DNA damage, cross-linking, and subsequent inhibition of DNA replication and transcription, ultimately inducing **apoptosis** in rapidly dividing cancer cells. *Folate analog* - Folate analogs like **methotrexate** inhibit **dihydrofolate reductase**, interfering with DNA synthesis by depleting tetrahydrofolate, a crucial cofactor for nucleotide synthesis. - While they are chemotherapeutic agents, they do not typically cause hemorrhagic cystitis; their common side effects include **myelosuppression**, mucositis, and hepatotoxicity. *Microtubule inhibitor* - Microtubule inhibitors such as **paclitaxel** and **vincristine** interfere with microtubule formation or breakdown, disrupting cell division (mitosis). - Common side effects include **neuropathy** and myelosuppression, but not hemorrhagic cystitis. *Platinum-based DNA cross-linking agent* - Platinum-based drugs like **cisplatin** and **carboplatin** are often used for ovarian cancer and cause nephrotoxicity, neurotoxicity, and ototoxicity. - They form **DNA adducts and interstrand cross-links**, inhibiting DNA replication and transcription, but do not directly cause acrolein-induced hemorrhagic cystitis. *BRAF inhibitor* - BRAF inhibitors (e.g., **vemurafenib**) are **targeted therapies** used in cancers with specific mutations, such as BRAF-mutated melanoma. - They inhibit the BRAF kinase in the MAPK signaling pathway, and while effective in specific contexts, they are not typically associated with hemorrhagic cystitis.

Anti-neoplastic drugs US Medical PG Question 4: A 62-year-old woman presents to her oncologist to discuss the chemotherapy options for her newly diagnosed breast cancer. During the meeting, they discuss a drug that inhibits the breakdown of mitotic spindles in cells. Her oncologist explains that this will be more toxic to cancer cells because those cells are dividing more rapidly. Which of the following side effects is closely associated with the use of this chemotherapeutic agent?

• A. Photosensitivity
• B. Peripheral neuropathy (Correct Answer)
• C. Paralytic ileus
• D. Hemorrhagic cystitis
• E. Pulmonary fibrosis

Anti-neoplastic drugs Explanation: ***Peripheral neuropathy*** - Drugs that inhibit the breakdown of **mitotic spindles** are **microtubule-targeting agents** (e.g., **taxanes** like paclitaxel/docetaxel, **vinca alkaloids** like vincristine/vinblastine). - These agents interfere with **microtubule function** in neurons, leading to **axonal damage** and **peripheral neuropathy**. - This is the **most characteristic and common dose-limiting toxicity** of microtubule inhibitors, affecting sensory and motor nerves (numbness, tingling, weakness in extremities). *Photosensitivity* - **Photosensitivity** is a common adverse effect associated with certain chemotherapeutic agents like **fluorouracil** (5-FU) or **methotrexate**, but is not linked to microtubule inhibitors. - It involves an increased sensitivity to UV light, often manifesting as a rash or exaggerated sunburn. *Paralytic ileus* - **Paralytic ileus** can occur with **vinca alkaloids** (especially vincristine) due to autonomic neuropathy affecting the **enteric nervous system**. - However, this is **less common** than peripheral neuropathy and occurs more specifically with vincristine rather than taxanes. - **Peripheral neuropathy** is the more pervasive, dose-limiting, and universally characteristic side effect across all microtubule inhibitors. *Hemorrhagic cystitis* - **Hemorrhagic cystitis** is a classic side effect of **alkylating agents** like **cyclophosphamide** and **ifosfamide**, which produce the toxic metabolite **acrolein**. - It is prevented/managed with **mesna**, which inactivates acrolein. - Not associated with microtubule inhibitors. *Pulmonary fibrosis* - **Pulmonary fibrosis** is a known side effect of certain chemotherapeutic drugs, most notably **bleomycin** and **busulfan**. - This adverse effect is not associated with agents that target **mitotic spindle breakdown**.

Anti-neoplastic drugs US Medical PG Question 5: A 57-year-old man presents to his oncologist to discuss management of small cell lung cancer. The patient is a lifelong smoker and was diagnosed with cancer 1 week ago. The patient states that the cancer was his fault for smoking and that there is "no hope now." He seems disinterested in discussing the treatment options and making a plan for treatment and followup. The patient says "he does not want any treatment" for his condition. Which of the following is the most appropriate response from the physician?

• A. "You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."
• B. "It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."
• C. "It must be very challenging having received this diagnosis. I want to work with you to create a plan." (Correct Answer)
• D. "We are going to need to treat your lung cancer. I am here to help you throughout the process."
• E. "I respect your decision and we will not administer any treatment. Let me know if I can help in any way."

Anti-neoplastic drugs Explanation: ***"It must be very challenging having received this diagnosis. I want to work with you to create a plan."*** - This response **acknowledges the patient's emotional distress** and feelings of guilt and hopelessness, which is crucial for building rapport and trust. - It also gently **re-engages the patient** by offering a collaborative approach to treatment, demonstrating the physician's commitment to supporting him through the process. *"You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."* - While acknowledging distress, sending the patient home without further engagement **delays urgent care** for small cell lung cancer, which is aggressive. - This response might be perceived as dismissive of his immediate feelings and can **exacerbate his sense of hopelessness** and isolation. *"It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."* - This statement moves too quickly to treatment efficacy without adequately addressing the patient's current **emotional state and fatalism**. - While factual, it **lacks empathy** for his personal feelings of blame and hopelessness, potentially making him feel unheard. *"We are going to need to treat your lung cancer. I am here to help you throughout the process."* - This response is **too directive and authoritarian**, which can alienate a patient who is already feeling guilty and resistant to treatment. - It fails to acknowledge his stated feelings of "no hope now" or his disinterest in treatment, which are critical to address before discussing the necessity of treatment. *"I respect your decision and we will not administer any treatment. Let me know if I can help in any way."* - While respecting patient autonomy is vital, immediately accepting a patient's decision to refuse treatment without exploring the underlying reasons (e.g., guilt, hopelessness, lack of information) is **premature and potentially harmful**. - The physician has a responsibility to ensure the patient is making an informed decision, especially for a rapidly progressing condition like small cell lung cancer.

Anti-neoplastic drugs US Medical PG Question 6: A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL fusion gene. A drug with which of the following mechanisms of action is most appropriate for this patient?

• A. Ribonucleotide reductase inhibitor
• B. Monoclonal anti-HER-2 antibody
• C. Topoisomerase II inhibitor
• D. Monoclonal anti-CD20 antibody
• E. Tyrosine kinase inhibitor (Correct Answer)

Anti-neoplastic drugs Explanation: ***Tyrosine kinase inhibitor*** - The patient's symptoms (abdominal discomfort, fatigue, weight loss, pallor, splenomegaly), laboratory findings (**anemia with pronounced leukocytosis and thrombocytosis**), and the presence of a **BCR-ABL fusion gene** are highly characteristic of **Chronic Myeloid Leukemia (CML)**. - The **BCR-ABL fusion gene** encodes a constitutively active **tyrosine kinase**, which is the hallmark of CML and the primary therapeutic target for **tyrosine kinase inhibitors (TKIs)** like imatinib. *Ribonucleotide reductase inhibitor* - **Ribonucleotide reductase inhibitors** (e.g., hydroxyurea) block DNA synthesis and are used in myeloproliferative disorders to reduce cell counts, but they are not specific to the **BCR-ABL fusion gene** and are not the most appropriate first-line targeted therapy for CML. - While they can control symptoms, they do not target the underlying molecular defect in CML as effectively as TKIs. *Monoclonal anti-HER-2 antibody* - **Monoclonal anti-HER-2 antibodies** (e.g., trastuzumab) are used to treat **HER-2 positive breast cancer** and some gastric cancers. - They are not relevant to the treatment of CML, which is characterized by the **BCR-ABL fusion gene**. *Topoisomerase II inhibitor* - **Topoisomerase II inhibitors** (e.g., etoposide, doxorubicin) prevent DNA unwinding and replication, leading to cell death, and are used in various hematologic malignancies and solid tumors. - These drugs are broad-spectrum chemotherapeutic agents not specifically targeted to the **BCR-ABL fusion protein** in CML and are not first-line therapy for this condition. *Monoclonal anti-CD20 antibody* - **Monoclonal anti-CD20 antibodies** (e.g., rituximab) target the CD20 protein on B lymphocytes and are primarily used to treat **B-cell non-Hodgkin lymphoma** and some autoimmune diseases. - They have no role in the direct treatment of CML, which is a myeloid malignancy.

Anti-neoplastic drugs US Medical PG Question 7: A 55-year-old man comes to the physician because of a 4-month history of fatigue, increased sweating, and a 5.4-kg (12-lb) weight loss. Over the past 3 weeks, he has had gingival bleeding when brushing his teeth. Twenty years ago, he was diagnosed with a testicular tumor and treated with radiation therapy. His temperature is 37.8°C (100°F), pulse is 70/min, respirations are 12/min, and blood pressure is 130/80 mm Hg. He takes no medications. Cardiopulmonary examination shows no abnormalities. The spleen is palpated 4 cm below the left costal margin. Laboratory studies show: Hemoglobin 9 g/dL Mean corpuscular volume 86 μm3 Leukocyte count 110,000/mm3 Segmented neutrophils 24% Metamyelocytes 6% Myelocytes 34% Promyelocytes 14% Blasts 1% Lymphocytes 11% Monocytes 4% Eosinophils 4% Basophils 2% Platelet count 650,000/mm3 Molecular testing confirms the diagnosis. Which of the following is the most appropriate next step in treatment?

• A. Phlebotomy
• B. Cytarabine and daunorubicin therapy
• C. Rituximab therapy
• D. Low-dose aspirin therapy
• E. Imatinib therapy (Correct Answer)

Anti-neoplastic drugs Explanation: ***Imatinib therapy*** - The patient's presentation with **fatigue**, **sweating**, **weight loss**, **gingival bleeding**, **splenomegaly**, and remarkable lab findings (**leukocytosis** with a left shift including **myelocytes**, **promyelocytes**, low blast count, **thrombocytosis**, and **anemia**) is highly suggestive of **Chronic Myeloid Leukemia (CML)**. - Molecular testing would confirm the presence of the **Philadelphia chromosome (BCR-ABL1 fusion gene)**, which is the target of **imatinib**, a tyrosine kinase inhibitor (TKI) and the first-line treatment for CML. *Phlebotomy* - **Phlebotomy** is a treatment for **polycythemia vera**, a myeloproliferative neoplasm characterized by an *elevated red blood cell count*, which is not present here (patient has anemia). - It aims to reduce blood viscosity and iron overload, which are not the primary issues in this patient. *Cytarabine and daunorubicin therapy* - This combination therapy (often termed "7+3" regimen) is standard induction chemotherapy for **Acute Myeloid Leukemia (AML)**. - The patient's **low blast count (1%)** and presence of various myeloid precursor stages define a chronic phase of a myeloproliferative neoplasm, not acute leukemia (which requires >20% blasts). *Rituximab therapy* - **Rituximab** is a monoclonal antibody that targets the **CD20 antigen** found on B-cells and is primarily used in the treatment of **B-cell non-Hodgkin lymphomas** and **Chronic Lymphocytic Leukemia (CLL)**. - This patient presents with a myeloid proliferation, not a lymphoid malignancy. *Low-dose aspirin therapy* - **Low-dose aspirin** is used for its antiplatelet effects to prevent thrombotic events, particularly in conditions like **essential thrombocythemia** or **polycythemia vera** where platelet counts or red cell mass are significantly elevated sometimes requiring aspirin if clots are forming. - While this patient has thrombocytosis, treating the underlying CML with imatinib is the priority and will typically normalize platelet counts, making aspirin a secondary or adjunct consideration if thrombosis risk is high and CML treatment is not yet effective.

Anti-neoplastic drugs US Medical PG Question 8: A 71-year-old woman presents to her hematologist-oncologist for follow up after having begun doxorubicin and cyclophosphamide in addition to radiation therapy for the treatment of her stage 3 breast cancer. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, the pulses are strong and irregular, she has a grade 3/6 holosystolic murmur heard best at the left upper sternal border, clear bilateral breath sounds, and erythema over her site of radiation. Which of the following statements regarding doxorubicin is true?

• A. Doxorubicin has a maximum lifetime dose, due to the risk of cardiac toxicity (Correct Answer)
• B. Doxorubicin has a maximum lifetime dose, due to the risk of pulmonary toxicity
• C. Doxorubicin will increase her risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)
• D. Doxorubicin frequently causes an acneiform rash
• E. Doxorubicin frequently causes cystitis

Anti-neoplastic drugs Explanation: ***Doxorubicin has a maximum lifetime dose, due to the risk of cardiac toxicity*** - **Doxorubicin** is a potent chemotherapy agent (anthracycline) with a well-known risk of **cardiotoxicity**, which can lead to **dilated cardiomyopathy** and heart failure. - To mitigate this severe side effect, a **cumulative lifetime dose limit** (usually 450-550 mg/m²) is established for doxorubicin. *Doxorubicin has a maximum lifetime dose, due to the risk of pulmonary toxicity* - While some chemotherapy agents can cause pulmonary toxicity, **doxorubicin** is not primarily associated with this as its main dose-limiting toxicity. - The most significant and common dose-limiting toxicity of doxorubicin is **cardiotoxicity**, not pulmonary. *Doxorubicin will increase her risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)* - Chemotherapy in general can increase the risk of **thromboembolic events**, but this is not a specific dose-limiting toxicity of **doxorubicin** that dictates a lifetime maximum dose. - The concern for DVT/PE is a broader complication of cancer and its treatment, distinct from doxorubicin's specific cardiac risk. *Doxorubicin frequently causes an acneiform rash* - **Acneiform rash** is a common side effect of epidermal growth factor receptor (EGFR) inhibitors (e.g., cetuximab, erlotinib), not typically associated with **doxorubicin**. - Doxorubicin's dermatologic side effects usually involve **alopecia**, hand-foot syndrome, and radiation recall, but not a predominant acneiform rash. *Doxorubicin frequently causes cystitis* - **Cystitis**, particularly hemorrhagic cystitis, is a well-known side effect of **cyclophosphamide** (another drug the patient is receiving), not **doxorubicin**. - **Mesna** is often administered with cyclophosphamide to prevent this urological toxicity.

Anti-neoplastic drugs US Medical PG Question 9: A 54-year-old woman is diagnosed with locally-advanced invasive ductal carcinoma of the breast. She undergoes surgical resection, radiation therapy, and is now being started on adjunctive chemotherapy with cyclophosphamide and doxorubicin. The patient is scheduled for follow up by her primary care provider. Which of the following tests should be performed regularly to monitor her current treatment regimen?

• A. No regular monitoring indicated
• B. Chest radiograph
• C. Cardiac MRI
• D. ECG
• E. Echocardiography (Correct Answer)

Anti-neoplastic drugs Explanation: ***Echocardiography*** - **Doxorubicin** is an anthracycline chemotherapy agent known for its dose-dependent **cardiotoxicity**, which can lead to **dilated cardiomyopathy** and heart failure. - Regular echocardiography is crucial to monitor **left ventricular ejection fraction (LVEF)** and detect early signs of cardiac dysfunction, allowing for timely intervention or adjustment of treatment. *No regular monitoring indicated* - This is incorrect as **doxorubicin**, a component of the chemotherapy regimen, has significant cardiotoxic effects that require close monitoring to prevent severe cardiac complications. - Neglecting monitoring could lead to irreversible cardiac damage. *Chest radiograph* - A chest radiograph primarily assesses lung fields and cardiac silhouette, but it is not sensitive enough to detect early-stage **doxorubicin-induced myocardial damage** or changes in **LVEF**. - While useful for detecting pulmonary complications or metastases, it is not the primary tool for monitoring cardiotoxicity. *Cardiac MRI* - Cardiac MRI is a highly sensitive and specific imaging modality for assessing cardiac function and structure, but it is typically reserved for cases where echocardiography findings are equivocal or more detailed assessment is needed. - It is not the routine or initial test for monitoring cardiotoxicity due to its higher cost and complexity. *ECG* - An ECG assesses the electrical activity of the heart and can detect arrhythmias or signs of ischemia, but it is generally not sufficient for monitoring **doxorubicin-induced cardiotoxicity**. - While it can show nonspecific changes, it does not directly measure changes in **LVEF** or structural heart damage, which are key indicators of cardiotoxicity.

Anti-neoplastic drugs US Medical PG Question 10: A 25-year-old college student is diagnosed with acute myelogenous leukemia after presenting with a 3-week history of fever, malaise, and fatigue. He has a history of type 1 diabetes mellitus, multiple middle ear infections as a child, and infectious mononucleosis in high school. He currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 17/min. On physical examination, his pulses are bounding; his complexion is pale, but breath sounds remain clear. A rapidly progressive form of leukemia is identified, and the patient is scheduled to start intravenous chemotherapy. Which of the following treatments should be given to this patient to prevent or decrease the likelihood of developing acute renal failure during treatment?

• A. Sulfinpyrazone
• B. Indomethacin
• C. Probenecid
• D. Colchicine
• E. Allopurinol (Correct Answer)

Anti-neoplastic drugs Explanation: ***Allopurinol*** - **Allopurinol** inhibits **xanthine oxidase**, preventing the conversion of xanthine and hypoxanthine to uric acid. - This is crucial in **tumor lysis syndrome** (TLS), a common complication of chemotherapy for rapidly proliferating cancers like AML, where massive cell death releases intracellular contents, including **purines**, which are metabolized to uric acid and can cause **acute renal failure**. *Sulfinpyrazone* - **Sulfinpyrazone** is a uricosuric agent, meaning it increases the excretion of uric acid in the urine. - It is generally contraindicated in TLS because the increased uric acid load in the renal tubules can **aggravate crystal formation** and worsen renal damage, rather than prevent it. *Indomethacin* - **Indomethacin** is a non-steroidal anti-inflammatory drug (NSAID) primarily used for pain and inflammation management. - While it can be used to treat the inflammation associated with **gouty arthritis**, it does not prevent the formation of uric acid during TLS and can even cause direct **renal toxicity**, which would be detrimental in a patient at risk of acute renal failure. *Probenecid* - **Probenecid** is another uricosuric agent, similar to sulfinpyrazone, that works by inhibiting the reabsorption of uric acid in the renal tubules. - Like other uricosurics, it is generally **contraindicated in TLS** due to the risk of exacerbating uric acid nephropathy and acute renal failure by increasing uric acid concentrations in the kidneys. *Colchicine* - **Colchicine** is an anti-inflammatory drug mainly used for the treatment of **acute gout attacks** and familial Mediterranean fever. - It does not lower serum uric acid levels and therefore offers no protection against the **hyperuricemia** and potential renal damage associated with tumor lysis syndrome.

Anti-neoplastic drugs Flashcard 1 of 10

Question: Cefepime is indicated as empiric therapy in _____

Answer: febrile neutropenia (quite specific)

Anti-neoplastic drugs Flashcard 2 of 10

Question: Bevacizumab is an antitumor monoclonal antibody that targets _____

Answer: VEGF

Anti-neoplastic drugs Flashcard 3 of 10

Question: Atezolizumab, durvalumab, and avelumab are checkpoint inhibitors that bind to _____ on tumor cells.

Answer: PD-L1

Anti-neoplastic drugs Flashcard 4 of 10

Question: Which antitumor antibiotic drug soley intercalates into DNA?_____

Answer: Actinomycin D

Anti-neoplastic drugs Flashcard 5 of 10

Question: Imatinib is a small molecule _____ inhibitor

Answer: tyrosine kinase

Anti-neoplastic drugs Flashcard 6 of 10

Question: Which antitumor monoclonal antibody is associated with heart failure (cardiotoxicity)? _____

Answer: trastuzumab (herceptin)

Extra Information:   Watch Rituximab, cetuximab, bevacizumab, alemtuzumab, trastuzumab [https://dashboard.sketchy.com/study/medical/courses/medical-pharmacology/units/medical-pharmacology-antineoplastics/videos/medical-pharmacology-antineoplastics-kinase-inhibitors-and-monoclonal-antibodies-rituximab-cetuximab-bevacizumab-alemtuzumab-trastuzumab?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/immunology/videos/transplant-rejection?index=16] https://onlinemeded.org/spa/immunology?ref=anki 

Anti-neoplastic drugs Flashcard 7 of 10

Question: Nivolumab is an anti-checkpoint monoclonal antibody that binds to _____ on T cells.

Answer: PD-1

Anti-neoplastic drugs Flashcard 8 of 10

Question: anastrazole

Answer:

Extra Information: breast cancer in postmenopausal womenaromatase inhibitor

Anti-neoplastic drugs Flashcard 9 of 10

Question: exemestane

Answer:

Extra Information: breast cancer in postmenopausal womenaromatase inhibitor

Anti-neoplastic drugs Flashcard 10 of 10

Question: alkylating agents

Answer: absence of digits (and multiple varied anomalies)