Anticancer Drugs Practice Questions

Q: A 58-year-old woman with a history of myocardial infarction and congestive heart failure has been diagnosed with locally advanced breast cancer and recommended for chemotherapy. Which antineoplastic drug should be best avoided?

Anthracycline. ### Explanation **Correct Option: A. Anthracyclines** Anthracyclines (e.g., **Doxorubicin, Daunorubicin**) are notorious for their **dose-dependent cardiotoxicity** [1]. The underlying mechanism involves the generation of iron-dependent free radicals (reactive oxygen species) that cause lipid peroxidation of the myocardial cell membrane [1]. Since the patient already has a history of myocardial infarction and congestive heart failure (CHF), using anthracyclines would significantly increase the risk of worsening her cardiac status or inducing irreversible dilated cardiomyopathy [1]. **Why other options are incorrect:** * **B. Alkylating agents:** While drugs like Cyclophosphamide can cause hemorrhagic cystitis (prevented by Mesna), they are generally not contraindicated in patients with pre-existing CHF, though high doses can occasionally cause acute myocarditis. * **C. Platinum compounds:** Cisplatin is primarily associated with nephrotoxicity, ototoxicity, and severe emesis. It does not have the same direct, cumulative cardiotoxic profile as anthracyclines. * **D. Bisphosphonates:** These are not antineoplastic drugs but are supportive therapies used to manage bone metastases or hypercalcemia of malignancy. Their primary side effects include osteonecrosis of the jaw and esophageal irritation. **High-Yield NEET-PG Pearls:** * **Dexrazoxane:** An iron-chelating agent used to prevent/reduce anthracycline-induced cardiotoxicity [1]. * **Monitoring:** Patients on Doxorubicin should be monitored via **ECHO or MUGA scans** to assess the Left Ventricular Ejection Fraction (LVEF) [1]. * **Liposomal Doxorubicin:** A formulation designed to reduce cardiac uptake and decrease toxicity. * **Trastuzumab:** Another breast cancer drug that causes cardiotoxicity, but unlike anthracyclines, its effect is usually **reversible** and not dose-dependent.

Q: Busulfan toxicity does not include which of the following?

Toxic carditis. **Explanation:** Busulfan is an alkylating agent (specifically an alkyl sulfonate) primarily used in the treatment of Chronic Myeloid Leukemia (CML) and as a conditioning agent before bone marrow transplantation. **Why "Toxic Carditis" is the correct answer:** Toxic carditis is not a recognized side effect of Busulfan. Cardiotoxicity (specifically hemorrhagic cystitis and cardiomyopathy) is more characteristically associated with high doses of **Cyclophosphamide**. Busulfan’s toxicity profile is primarily focused on the lungs, skin, and bone marrow. **Analysis of Incorrect Options:** * **A. Hyperpigmentation:** Busulfan frequently causes a "tan-like" skin hyperpigmentation. In some cases, this is part of **"Busulfan-induced Addison-like syndrome,"** characterized by wasting, hypotension, and skin darkening, though without actual adrenal insufficiency (normal cortisol levels). * **C. Hyperuricemia:** Like most cytotoxic drugs that cause rapid tumor cell lysis (Tumor Lysis Syndrome), Busulfan leads to increased purine catabolism, resulting in elevated uric acid levels. * **D. Pulmonary Fibrosis:** This is a classic, high-yield side effect known as **"Busulfan Lung."** It is a dose-dependent interstitial pulmonary fibrosis that can occur months to years after treatment. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Busulfan:** **B**-**B**-**B** (Bone marrow suppression, Busulfan Lung, Bronze skin). * **Seizures:** At high doses (conditioning regimens), Busulfan crosses the blood-brain barrier and can cause seizures; prophylactic anticonvulsants (like Phenytoin) are often administered. * **Veno-occlusive disease (VOD):** Busulfan is a major risk factor for hepatic VOD (Sinusoidal Obstruction Syndrome) during transplant conditioning.

Q: A 40-year-old woman, who has been on chemotherapy for 6 months for ovarian carcinoma, presents with progressive bilateral sensorineural hearing loss. Which drug is responsible for this adverse effect?

Cisplatin. **Explanation:** The correct answer is **Cisplatin**. **1. Why Cisplatin is correct:** Cisplatin is a potent platinum-based alkylating agent used frequently in ovarian, lung, and bladder cancers. Its most characteristic dose-limiting toxicities are **nephrotoxicity** and **ototoxicity**. The drug causes damage to the hair cells in the cochlea and the stria vascularis, leading to progressive, bilateral, and often irreversible **high-frequency sensorineural hearing loss** and tinnitus. Amifostine (a cytoprotective agent) is sometimes used to reduce cisplatin-induced nephrotoxicity, though its role in preventing ototoxicity is less established. **2. Why other options are incorrect:** * **Doxorubicin:** An anthracycline primarily known for **cardiotoxicity** (dilated cardiomyopathy) due to free radical generation. It does not cause hearing loss. * **Cyclophosphamide:** An alkylating agent (nitrogen mustard) most famous for causing **hemorrhagic cystitis** due to the metabolite acrolein. This can be prevented with aggressive hydration and **MESNA**. * **Paclitaxel:** A taxane that inhibits microtubule disassembly. Its hallmark toxicity is **peripheral neuropathy** (stocking-and-glove distribution) and myelosuppression, not ototoxicity. **High-Yield Clinical Pearls for NEET-PG:** * **Platinum Compounds:** Cisplatin (Ototoxicity/Nephrotoxicity), Carboplatin (Myelosuppression/Thrombocytopenia), Oxaliplatin (Cold-induced peripheral neuropathy). * **Ototoxic Drugs Mnemonic:** "A-C-E-L" (Aminoglycosides, Cisplatin, Erythromycin, Loop diuretics). * **Vincristine vs. Vinblastine:** Vincristine causes peripheral neuropathy (nerve damage); Vinblastine causes bone marrow suppression (blasts the marrow).

Q: Which of the following monoclonal antibodies is used for the treatment of colorectal carcinoma?

Cetuximab. **Explanation:** **Correct Answer: B. Cetuximab** Cetuximab is a recombinant human/mouse chimeric monoclonal antibody that targets the **Epidermal Growth Factor Receptor (EGFR)**. In colorectal carcinoma, EGFR is often overexpressed, leading to uncontrolled cell proliferation. By binding to the extracellular domain of EGFR, Cetuximab inhibits downstream signaling pathways (like KRAS/MAPK). * **High-Yield Note:** It is only effective in patients with **wild-type KRAS** genes. If a patient has a KRAS mutation, the pathway remains "on" regardless of EGFR inhibition, making the drug ineffective. **Incorrect Options:** * **A. Pembrolizumab:** This is a **PD-1 inhibitor** (checkpoint inhibitor). While used for various solid tumors, its specific indication in colorectal cancer is limited to cases with **Microsatellite Instability-High (MSI-H)** or mismatch repair deficiency (dMMR), rather than being the primary targeted therapy for general colorectal carcinoma. * **C. Rituximab:** This is a chimeric monoclonal antibody against **CD20**, primarily found on B-cells. It is used in the treatment of Non-Hodgkin Lymphoma (NHL), Chronic Lymphocytic Leukemia (CLL), and autoimmune conditions like Rheumatoid Arthritis. * **D. Natalizumab:** This antibody targets **α4-integrin**. It is used in the management of **Multiple Sclerosis** and Crohn’s disease by preventing leukocyte migration into inflamed tissues. **Clinical Pearls for NEET-PG:** 1. **Panitumumab** is another EGFR inhibitor used in colorectal cancer (fully humanized). 2. **Bevacizumab** (anti-VEGF) is also used in colorectal cancer to inhibit angiogenesis. 3. **Side Effect:** EGFR inhibitors like Cetuximab characteristically cause an **acneiform skin rash**; the presence of the rash often correlates with a positive therapeutic response.

Q: Irreversible ototoxicity is caused by which of the following drugs?

Cisplatin. **Explanation:** **Cisplatin** is a potent platinum-based alkylating agent used for various solid tumors. Its most characteristic dose-limiting toxicities are **nephrotoxicity** and **ototoxicity**. The ototoxicity is typically **bilateral, progressive, and irreversible**. It occurs because cisplatin induces the formation of reactive oxygen species (ROS) in the stria vascularis and hair cells of the cochlea, leading to permanent cell death. It initially affects high-frequency hearing (tinnitus is an early sign) before progressing to lower frequencies. **Analysis of Incorrect Options:** * **Cyclophosphamide:** Known primarily for **hemorrhagic cystitis** (due to the metabolite acrolein) and bone marrow suppression. It does not cause significant ototoxicity. * **Bleomycin:** Its most notorious side effect is **pulmonary fibrosis** and skin hyperpigmentation. It is "myelosuppressive-sparing" and does not affect hearing. * **Chlorambucil:** An alkylating agent used mainly in Chronic Lymphocytic Leukemia (CLL). Its primary toxicity is myelosuppression and potential secondary malignancies; it is not associated with ototoxicity. **Clinical Pearls for NEET-PG:** * **Amifostine:** A cytoprotective agent (free radical scavenger) that can be used to reduce cisplatin-induced nephrotoxicity. * **Vigorous Hydration:** The primary preventive measure for cisplatin-induced renal damage. * **Emetogenic Potential:** Cisplatin is the most highly emetogenic chemotherapy drug (requires NK1 receptor antagonists like Aprepitant). * **Other Ototoxic Drugs:** Remember the mnemonic "SALTA" (Salicylates, Aminoglycosides, Loop diuretics, Thalidomide, Antimalarials/Anticancer like Cisplatin).

Q: Which of the following drugs has the least bone marrow suppression?

Vincristine. The correct answer is **Vincristine**. ### **Explanation** The primary dose-limiting toxicity of most cytotoxic chemotherapy agents is **myelosuppression** (bone marrow suppression). However, certain drugs are known for being "bone marrow sparing." **Vincristine**, a Vinca alkaloid that inhibits microtubule assembly (mitotic inhibitor), is unique because it causes **minimal to no bone marrow suppression**. Its dose-limiting toxicity is instead **peripheral neuropathy** (paresthesia, loss of deep tendon reflexes, and autonomic dysfunction like constipation). ### **Analysis of Incorrect Options** * **Cisplatin:** A platinum compound known for being highly emetogenic and nephrotoxic, but it also causes significant cumulative myelosuppression. * **Cyclophosphamide:** An alkylating agent that causes significant neutropenia. Its other classic side effect is hemorrhagic cystitis (prevented by Mesna). * **Methotrexate:** An antimetabolite (folate antagonist) that is highly myelosuppressive. This effect is managed using "Leucovorin rescue." ### **High-Yield Clinical Pearls for NEET-PG** * **Bone Marrow Sparing Agents:** Remember the mnemonic **"V-B-L-S"** for drugs with minimal myelosuppression: **V**incristine, **B**leomycin (Lung fibrosis), **L**-Asparaginase (Pancreatitis/Thrombosis), and **S**teroids. * **Vincristine vs. Vinblastine:** While they belong to the same class, **V**inblastine "**B**lasts" the bone marrow (highly myelosuppressive), whereas **V**incristine spares it. * **Vincristine Warning:** It is **fatal if given intrathecally**; it must only be administered intravenously.

Q: A patient undergoing chemotherapy for two weeks for a mediastinal tumor develops high-frequency hearing loss. What is the most probable cause of this condition?

Cisplatin. ### Explanation **Correct Option: A. Cisplatin** Cisplatin is a potent platinum-based alkylating agent used for various solid tumors (e.g., testicular, lung, and mediastinal tumors). Its most characteristic dose-limiting toxicities are **nephrotoxicity** and **ototoxicity**. * **Mechanism of Ototoxicity:** Cisplatin causes the generation of reactive oxygen species (ROS) in the **stria vascularis** and destroys the **outer hair cells** of the organ of Corti. * **Clinical Presentation:** It typically presents as bilateral, irreversible, **high-frequency hearing loss** (tinnitus is often the first sign). This aligns perfectly with the patient's symptoms. **Why Incorrect Options are Wrong:** * **B. Etoposide:** A topoisomerase II inhibitor primarily associated with **myelosuppression** and secondary leukemias. It does not cause hearing loss. * **C. Doxorubicin:** An anthracycline antibiotic famous for **cardiotoxicity** (dilated cardiomyopathy) due to free radical generation in the myocardium. * **D. Methotrexate:** An antimetabolite (folate antagonist) known for **mucositis**, bone marrow suppression, and hepatotoxicity. It is not ototoxic. **High-Yield Clinical Pearls for NEET-PG:** * **Amifostine:** A cytoprotective agent (free radical scavenger) used to reduce cisplatin-induced nephrotoxicity. * **Vigorous Hydration:** The primary strategy to prevent cisplatin-induced renal damage. * **Emetic Potential:** Cisplatin is the most highly emetogenic chemotherapy drug (requires NK1 receptor antagonists like Aprepitant). * **Other Ototoxic Drugs:** Loop diuretics (Furosemide), Aminoglycosides (Gentamicin), and Vancomycin. When combined with Cisplatin, the risk of permanent deafness increases significantly.

Q: Which of the following is an anti-CD20 monoclonal antibody?

Tositumomab. **Explanation:** **Tositumomab** is a murine IgG1 monoclonal antibody directed against the **CD20 antigen**, which is primarily expressed on the surface of normal and malignant B-lymphocytes. It is often used as a radiopharmaceutical (Iodine-131 tositumomab) for the treatment of relapsed or refractory follicular lymphoma. By binding to CD20, it induces cell death through antibody-dependent cell-mediated cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and apoptosis. **Analysis of Incorrect Options:** * **Alemtuzumab (Option A):** This is a monoclonal antibody directed against **CD52**, found on B and T lymphocytes. It is used in Chronic Lymphocytic Leukemia (CLL) and Multiple Sclerosis. * **Bevacizumab (Option B):** This is an angiogenesis inhibitor that targets **VEGF (Vascular Endothelial Growth Factor)**, not a surface cluster of differentiation (CD) marker. It is used in colorectal, lung, and renal cancers. * **Gemtuzumab (Option C):** This is an antibody-drug conjugate directed against **CD33**, which is expressed on leukemic blasts in Acute Myeloid Leukemia (AML). **High-Yield Clinical Pearls for NEET-PG:** * **CD20 Inhibitors:** Other high-yield anti-CD20 antibodies include **Rituximab** (chimeric), **Ofatumumab** (human), and **Obinutuzumab**. * **Mnemonic for CD Markers:** * **C**-D**20** = **R**ituximab (**20** looks like **R** flipped). * **C**-D**33** = **G**emtuzumab (**3** looks like **G**). * **C**-D**52** = **A**lemtuzumab (**5-2** = 3; but remember it as the "A" drug). * **Trastuzumab** targets **HER2/neu** (ErbB2) and is a classic question for breast cancer management.

Q: What is the mechanism of action of tacrolimus?

Calcineurin inhibitor. **Explanation:** **Mechanism of Action (Correct Answer: B)** Tacrolimus (FK506) is a potent immunosuppressant that belongs to the class of **Calcineurin Inhibitors**. It binds to an intracellular protein called **FK-binding protein (FKBP-12)**. This tacrolimus-FKBP complex then inhibits calcineurin, a phosphatase responsible for dephosphorylating the **Nuclear Factor of Activated T-cells (NFAT)**. Without dephosphorylation, NFAT cannot enter the nucleus to promote the transcription of **Interleukin-2 (IL-2)** and other cytokines, thereby preventing T-lymphocyte activation. **Analysis of Incorrect Options:** * **A. Folate antagonist:** This describes drugs like **Methotrexate**, which inhibit dihydrofolate reductase (DHFR) to interfere with DNA synthesis. * **C. Antimetabolite:** This refers to drugs like **5-Fluorouracil, Azathioprine, or Cytarabine** that mimic natural substrates to inhibit nucleic acid synthesis. * **D. CD 20 antibody:** This is the mechanism of **Rituximab**, a monoclonal antibody used in B-cell lymphomas and certain autoimmune conditions. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Use:** Primary drug for preventing organ rejection in liver, kidney, and heart transplants; also used topically for atopic dermatitis. * **Side Effects:** Nephrotoxicity (most common), neurotoxicity (tremors, seizures), and **post-transplant diabetes mellitus (PTDM)**. * **Comparison:** Unlike Cyclosporine (which binds to Cyclophilin), Tacrolimus is more potent and does **not** typically cause gingival hyperplasia or hirsutism. * **Metabolism:** It is metabolized by **CYP3A4**; therefore, grapefruit juice and macrolides can increase its toxicity.

Q: Red discoloration of urine is seen with which of the following medications?

Doxorubicin. **Explanation:** **Doxorubicin** (and its analog Daunorubicin) is an Anthracycline antibiotic used in cancer chemotherapy. The correct answer is Doxorubicin because it is a **naturally red-colored compound**. After administration, the drug and its metabolites are excreted via the kidneys, leading to a benign but striking **red discoloration of the urine** (chromaturia). Patients should be counseled about this side effect to prevent unnecessary alarm. **Analysis of Incorrect Options:** * **Methotrexate:** An antimetabolite (folate antagonist) primarily known for causing myelosuppression, mucositis, and hepatotoxicity. It does not typically change urine color. * **Cytarabine (Ara-C):** A pyrimidine antagonist used in leukemias. Its major dose-limiting toxicity is myelosuppression and cerebellar ataxia at high doses. * **Cisplatin:** A platinum compound known for its significant **nephrotoxicity** and ototoxicity. While it affects the kidneys, it does not cause red discoloration of urine. **High-Yield Clinical Pearls for NEET-PG:** * **Cardiotoxicity:** The most serious side effect of Doxorubicin is cumulative, dose-dependent cardiotoxicity (dilated cardiomyopathy). **Dexrazoxane** is the iron-chelating agent used to prevent this. * **Mechanism:** Anthracyclines work by inhibiting **Topoisomerase II**, intercalating DNA, and generating free radicals. * **Other "Red" Drugs:** Apart from Doxorubicin, **Rifampin** (antitubercular) and **Clofazimine** (antileprotic) are classic causes of red/orange discoloration of body fluids. * **Cyclophosphamide:** Contrast this with Doxorubicin; Cyclophosphamide causes **Hemorrhagic Cystitis** (bloody urine), which is prevented by **MESNA**.

Question 1

A 58-year-old woman with a history of myocardial infarction and congestive heart failure has been diagnosed with locally advanced breast cancer and recommended for chemotherapy. Which antineoplastic drug should be best avoided?

Accepted Answer

Anthracycline

Answer

Alkylating agent

Answer

Platinum compound

Answer

Bisphosphonates

Question 2

Busulfan toxicity does not include which of the following?

Accepted Answer

Toxic carditis

Answer

Hyperpigmentation

Answer

Hyperuricemia

Answer

Pulmonary fibrosis

Question 3

A 40-year-old woman, who has been on chemotherapy for 6 months for ovarian carcinoma, presents with progressive bilateral sensorineural hearing loss. Which drug is responsible for this adverse effect?

Accepted Answer

Cisplatin

Answer

Doxorubicin

Answer

Cyclophosphamide

Answer

Paclitaxel

Question 4

Which of the following monoclonal antibodies is used for the treatment of colorectal carcinoma?

Accepted Answer

Cetuximab

Answer

Pembrolizumab

Answer

Rituximab

Answer

Natalizumab

Question 5

Irreversible ototoxicity is caused by which of the following drugs?

Accepted Answer

Cisplatin

Answer

Cyclophosphamide

Answer

Bleomycin

Answer

Chlorambucil

Question 6

Which of the following drugs has the least bone marrow suppression?

Accepted Answer

Vincristine

Answer

Cisplatin

Answer

Cyclophosphamide

Answer

Methotrexate

Question 7

A patient undergoing chemotherapy for two weeks for a mediastinal tumor develops high-frequency hearing loss. What is the most probable cause of this condition?

Accepted Answer

Cisplatin

Answer

Etoposide

Answer

Doxorubicin

Answer

Methotrexate

Question 8

Which of the following is an anti-CD20 monoclonal antibody?

Accepted Answer

Tositumomab

Answer

Alemtuzumab

Answer

Bevacizumab

Answer

Gemtuzumab

Question 9

What is the mechanism of action of tacrolimus?

Accepted Answer

Calcineurin inhibitor

Answer

Folate antagonist

Answer

Antimetabolite

Answer

CD 20 antibody

Question 10

Red discoloration of urine is seen with which of the following medications?

Accepted Answer

Doxorubicin

Answer

Methotrexate

Answer

Cytarabine

Answer

Cisplatin

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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