Anticancer Drugs Practice Questions

Q: All of the following anticancer drugs are cell cycle non-specific except?

Vincristine. ### Explanation The classification of anticancer drugs based on cell cycle kinetics is a high-yield topic for NEET-PG. Drugs are categorized into **Cell Cycle Specific (CCS)** agents, which act on specific phases (e.g., M or S phase), and **Cell Cycle Non-Specific (CCNS)** agents, which act on both resting and dividing cells. **Why Vincristine is the Correct Answer:** Vincristine is a **Vinca alkaloid** that acts specifically during the **M-phase (Mitosis)**. It binds to tubulin and inhibits its polymerization into microtubules, preventing the formation of the mitotic spindle. This leads to mitotic arrest in metaphase. Since it targets a specific phase, it is a **Cell Cycle Specific (CCS)** drug. **Analysis of Incorrect Options:** * **Cisplatin (Option A):** A platinum coordination complex that cross-links DNA. It is **CCNS**, although it shows maximum toxicity during the G1 and S phases. * **Mitomycin-C (Option C):** An antitumor antibiotic that acts as an alkylating agent. It is **CCNS** and is particularly effective against hypoxic tumor cells. * **Cyclophosphamide (Option D):** An alkylating agent (nitrogen mustard) that causes DNA cross-linking. Alkylating agents are the classic examples of **CCNS** drugs because they damage DNA regardless of the cell cycle stage. **High-Yield Clinical Pearls for NEET-PG:** * **CCS Drugs:** Remember the mnemonic **"M-S-G"**: **M**-phase (Vincas, Taxanes), **S**-phase (Antimetabolites like Methotrexate, 5-FU), and **G2**-phase (Bleomycin). * **CCNS Drugs:** Alkylating agents, Platinum compounds, and Anthracyclines (Doxorubicin). * **Vincristine Side Effect:** Distinctive for **peripheral neuropathy** (paresthesia, loss of reflexes) and **constipation** (paralytic ileus), but notably **bone marrow sparing**.

Q: Bevacizumab is used for the treatment of which carcinoma?

Breast. **Explanation:** **Bevacizumab** is a recombinant humanized monoclonal antibody that acts as a potent **VEGF (Vascular Endothelial Growth Factor) inhibitor**. It binds to circulating VEGF-A, preventing it from interacting with its receptors (VEGFR-1 and VEGFR-2) on the surface of endothelial cells. This inhibits **angiogenesis** (the formation of new blood vessels), thereby "starving" the tumor of the blood supply necessary for growth and metastasis. 1. **Why Breast Carcinoma is correct:** Bevacizumab is FDA-approved and widely used in the management of **metastatic HER2-negative breast cancer**, typically in combination with chemotherapy (like paclitaxel). It helps in delaying disease progression by limiting the tumor's vascular network. 2. **Why other options are incorrect:** While Bevacizumab is used in several solid tumors (Colorectal, Renal Cell, and Non-Small Cell Lung Cancer), in the context of this specific question and standard NEET-PG patterns, **Breast Cancer** is a primary indication. While it is used in Lung cancer, it is specifically for *non-squamous* NSCLC; however, Breast cancer remains a classic textbook association for this drug's clinical utility. It is not a standard first-line treatment for Gastric (Stomach) carcinoma (where Trastuzumab or Ramucirumab are more commonly discussed). **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Angiogenesis inhibitor (Anti-VEGF). * **Adverse Effects:** The most characteristic side effects are **Hypertension**, **Proteinuria**, impaired wound healing, and increased risk of gastrointestinal perforation/hemorrhage. * **Other Indications:** Metastatic colorectal cancer (first-line), Glioblastoma multiforme, and Age-related Macular Degeneration (off-label/intravitreal). * **Contraindication:** It should be avoided for at least 28 days before or after elective surgery due to wound healing complications.

Q: Rituximab is used in all of the following conditions except:

PNH. **Explanation:** **Rituximab** is a chimeric monoclonal antibody directed against the **CD20 antigen**, which is primarily expressed on the surface of mature B-lymphocytes [1]. By binding to CD20, it mediates B-cell lysis through complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity [1]. * **Why PNH is the correct answer:** Paroxysmal Nocturnal Hemoglobinuria (PNH) is a stem cell disorder characterized by a deficiency of GPI-anchored proteins (like CD55 and CD59), leading to complement-mediated hemolysis of RBCs. Rituximab has no role here because the pathology involves the complement system attacking red blood cells, not B-cells. The drug of choice for PNH is **Eculizumab** (a C5 complement inhibitor). * **Why other options are incorrect:** * **NHL (Non-Hodgkin Lymphoma):** Rituximab is a cornerstone of therapy for B-cell NHLs (e.g., Diffuse Large B-cell Lymphoma) because these malignant cells overexpress CD20 [1]. * **RA (Rheumatoid Arthritis):** It is used in refractory RA to deplete the B-cells responsible for producing autoantibodies and presenting antigens to T-cells. * **SLE (Systemic Lupus Erythematosus):** While often used off-label, Rituximab is a recognized treatment for severe or refractory SLE to reduce the B-cell population. **Clinical Pearls for NEET-PG:** 1. **Infusion Reaction:** The most common side effect; managed by pre-medicating with antihistamines and acetaminophen [1]. 2. **HBV Reactivation:** Always screen for Hepatitis B before starting Rituximab, as it can cause fatal viral reactivation [1]. 3. **PML:** It is associated with Progressive Multifocal Leukoencephalopathy (JC virus reactivation) [1]. 4. **Other Indications:** ITP, Pemphigus vulgaris, and Wegener’s Granulomatosis (GPA).

Q: Which of the following is an IL-2 receptor inhibitor?

Both Basiliximab and Daclizumab. **Explanation:** **Mechanism of Action:** Basiliximab and Daclizumab are monoclonal antibodies that function as **IL-2 receptor antagonists**. Specifically, they bind to the **alpha subunit (CD25)** of the IL-2 receptor expressed on the surface of activated T-lymphocytes. By blocking this receptor, they inhibit IL-2 mediated T-cell proliferation, which is a critical step in the cellular immune response. **Analysis of Options:** * **Basiliximab:** A chimeric (murine-human) monoclonal antibody. It has a high affinity for the CD25 receptor and is currently the most commonly used IL-2 receptor antagonist in clinical practice. * **Daclizumab:** A humanized monoclonal antibody. While it also targets the CD25 receptor, it was primarily used for multiple sclerosis but has been largely withdrawn from the market due to safety concerns (hepatic injury). However, pharmacologically, it remains classified as an IL-2 receptor inhibitor. * **Conclusion:** Since both drugs share the same mechanism of inhibiting the IL-2 receptor, **Option C** is the correct answer. **NEET-PG High-Yield Pearls:** 1. **Clinical Use:** These drugs are primarily used for the **prophylaxis of acute organ rejection** in renal transplant patients (induction therapy). 2. **Side Effects:** Generally well-tolerated; however, they can cause hypersensitivity reactions and increased susceptibility to infections. 3. **Mnemonic:** Remember **"BD"** (Basiliximab/Daclizumab) for **"Blocking CD25"**. 4. **Distinction:** Unlike Cyclosporine or Tacrolimus (which inhibit IL-2 *production* via calcineurin inhibition), these drugs inhibit the IL-2 *receptor* directly.

Q: Which anticancer drug, also used in Rheumatoid Arthritis, produces acrolein in urine that leads to hemorrhagic cystitis?

Cyclophosphamide. ### Explanation **Correct Answer: A. Cyclophosphamide** **Mechanism and Pathophysiology:** Cyclophosphamide is an **alkylating agent** (nitrogen mustard) that acts as a prodrug. It is activated in the liver by cytochrome P450 enzymes into 4-hydroxycyclophosphamide, which eventually breaks down into two active metabolites: **phosphoramide mustard** (the cytotoxic component) and **acrolein**. Acrolein is a toxic byproduct excreted in the urine. It causes direct irritation and sloughing of the bladder mucosal lining, leading to **hemorrhagic cystitis**. Clinically, this presents as gross hematuria and dysuria. Beyond oncology, it is widely used as a Disease-Modifying Antirheumatic Drug (DMARD) for severe Rheumatoid Arthritis and systemic vasculitis. **Analysis of Incorrect Options:** * **B. Busulfan:** An alkylating agent primarily used in Chronic Myeloid Leukemia (CML) and bone marrow ablation. Its classic side effects include **pulmonary fibrosis** ("Busulfan lung"), adrenal insufficiency-like syndrome, and skin hyperpigmentation. * **C. Procarbazine:** A methylating agent used in Hodgkin’s lymphoma. It is known for causing **disulfiram-like reactions** with alcohol and hypertensive crises when taken with tyramine-rich foods (MAO inhibition). * **D. Mesna:** This is not an anticancer drug but a **cytoprotective agent**. It is the specific antidote used to *prevent* hemorrhagic cystitis by neutralizing acrolein in the bladder. **NEET-PG High-Yield Pearls:** * **Prevention of Hemorrhagic Cystitis:** Managed by aggressive hydration and administration of **Mesna** (2-MercaptoEthane Sulfonate Na). * **Other Side Effects:** Cyclophosphamide is also associated with SIADH and infertility (premature ovarian failure/azoospermia). * **Ifosfamide:** A related drug that produces even higher levels of acrolein and *always* requires Mesna co-administration.

Q: Which monoclonal antibody is used in the treatment of head and neck cancer?

Pembrolizumab. **Explanation:** **Pembrolizumab** is a humanized monoclonal antibody that targets the **Programmed Cell Death Protein 1 (PD-1)** receptor on T-cells. By blocking the interaction between PD-1 and its ligands (PD-L1/PD-L2), it prevents the "immune checkpoint" inhibition used by tumor cells to evade the immune system. It is FDA-approved for **recurrent or metastatic Squamous Cell Carcinoma of the Head and Neck (HNSCC)**, either as monotherapy or in combination with platinum-based chemotherapy. **Analysis of Incorrect Options:** * **Trastuzumab:** A monoclonal antibody against **HER2/neu** receptors. It is primarily used in HER2-positive breast cancer and gastric adenocarcinoma. * **Rituximab:** A chimeric antibody against the **CD20** antigen found on B-cells. It is the gold standard for B-cell Non-Hodgkin Lymphomas (e.g., Diffuse Large B-cell Lymphoma) and Chronic Lymphocytic Leukemia (CLL). * **Ocrelizumab:** A humanized anti-CD20 antibody used specifically for the treatment of **Multiple Sclerosis (MS)**, not solid tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Cetuximab:** Another high-yield antibody for Head and Neck cancer; it targets the **EGFR** (Epidermal Growth Factor Receptor). * **Nivolumab:** Like Pembrolizumab, it is a PD-1 inhibitor also used in HNSCC. * **Adverse Effect:** Immune-checkpoint inhibitors like Pembrolizumab commonly cause **immune-related Adverse Events (irAEs)**, such as colitis, pneumonitis, and endocrinopathies (hypophysitis).

Q: Maintenance of high urinary pH is important during methotrexate treatment because:

Methotrexate is a weak acid. ### Explanation **1. Why the Correct Answer is Right:** Methotrexate (MTX) is a **weak organic acid** ($pK_a$ ≈ 4.8). In an acidic environment (low pH), it remains in its non-ionized, lipid-soluble form, which is poorly soluble in water. This leads to the precipitation of MTX and its metabolite (7-OH-methotrexate) in the renal tubules, causing **crystalluria and acute kidney injury (AKI)**. By maintaining a **high urinary pH** (alkalinization, usually with Sodium Bicarbonate), the drug is converted into its **ionized (salt) form**. Ionized molecules are highly water-soluble and cannot be easily reabsorbed by the renal tubules, thereby enhancing excretion and preventing crystal-induced nephrotoxicity. **2. Analysis of Incorrect Options:** * **Option A:** While hydration helps, bladder irritation (hemorrhagic cystitis) is specifically associated with Cyclophosphamide/Ifosfamide (due to Acrolein), not MTX. * **Option B:** Alkalinization actually *increases* the clearance of MTX. Decreasing tubular secretion would increase systemic toxicity, which is the opposite of the goal. * **Option C:** Leucovorin (Folinic acid) is the *rescue agent* used to bypass the metabolic block; it does not become "toxic" in dehydrated patients, though its efficacy depends on adequate MTX clearance. **3. High-Yield Clinical Pearls for NEET-PG:** * **The "Rescue" Protocol:** High-dose MTX requires **vigorous hydration, urinary alkalinization (pH >7.0), and Leucovorin rescue** (to provide a source of reduced folate for healthy cells). * **Drug Interactions:** Avoid **NSAIDs, Salicylates, and Sulfonamides** with MTX, as they compete for renal tubular secretion and displace MTX from albumin, increasing toxicity. * **Antidote for Toxicity:** In cases of MTX-induced renal failure where clearance is stalled, **Glucarpidase** (carboxypeptidase G2) is used to rapidly break down extracellular MTX.

Q: Rituximab is a targeted antibody against which antigen?

CD 20. **Explanation:** **Rituximab** is a chimeric monoclonal antibody that specifically targets the **CD20 antigen**. CD20 is a transmembrane protein expressed primarily on the surface of pre-B and mature B-lymphocytes, but not on hematopoietic stem cells or plasma cells. When Rituximab binds to CD20, it triggers B-cell lysis through antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and induction of apoptosis. **Analysis of Options:** * **CD 20 (Correct):** The hallmark target for Rituximab. It is used clinically in B-cell Non-Hodgkin Lymphomas (e.g., Diffuse Large B-cell Lymphoma, Follicular Lymphoma), Chronic Lymphocytic Leukemia (CLL), and autoimmune conditions like Rheumatoid Arthritis and Wegener's Granulomatosis. * **CD 22:** This is the target for drugs like **Epratuzumab** and **Inotuzumab ozogamicin**. It is also expressed on B-cells but is distinct from the Rituximab binding site. * **CD 34:** This is a marker for **hematopoietic stem cells**. Targeting this would lead to bone marrow aplasia; it is primarily used in pathology to identify precursors in acute leukemias. * **CD 55:** Also known as Decay-Accelerating Factor (DAF). It protects cells from complement-mediated lysis. Deficiency of CD55 (and CD59) is seen in **Paroxysmal Nocturnal Hemoglobinuria (PNH)**. **High-Yield Clinical Pearls for NEET-PG:** * **Infusion Reaction:** The most common side effect of Rituximab is a cytokine release syndrome during the first infusion (pre-medicate with paracetamol and antihistamines). * **HBV Reactivation:** Always screen for Hepatitis B before starting Rituximab, as it can cause fatal viral reactivation. * **PML:** Rituximab is associated with Progressive Multifocal Leukoencephalopathy (JC virus reactivation).

Question 1

All of the following anticancer drugs are cell cycle non-specific except?

Accepted Answer

Vincristine

Answer

Cisplatin

Answer

Mitomycin-C

Answer

Cyclophosphamide

Question 2

Bevacizumab is used for the treatment of which carcinoma?

Accepted Answer

Breast

Answer

Stomach

Answer

Lung

Answer

None of the above

Question 3

A 56-year-old female presented with breast carcinoma and was prescribed herceptin (trastuzumab). Which of the following statements regarding this drug is true?

Accepted Answer

It is a monoclonal antibody produced by injecting the HER2 antigen.

Answer

It is an antibody produced entirely from mice, containing no human component.

Answer

Injection of herceptin increases the antibody response.

Answer

The protein HER2/Neu is expressed in increased amounts by breast cancer cells.

Question 4

Which of the following immunosuppressives does NOT cause profound myelosuppression?

Accepted Answer

Cyclosporine

Answer

Sirolimus

Answer

Azathioprine

Answer

Mercaptopurine

Question 5

Rituximab is used in all of the following conditions except:

Accepted Answer

PNH

Answer

NHL

Answer

RA

Answer

SLE

Question 6

Which of the following is an IL-2 receptor inhibitor?

Accepted Answer

Both Basiliximab and Daclizumab

Answer

Basiliximab

Answer

Daclizumab

Answer

None of the above

Question 7

Which anticancer drug, also used in Rheumatoid Arthritis, produces acrolein in urine that leads to hemorrhagic cystitis?

Accepted Answer

Cyclophosphamide

Answer

Busulfan

Answer

Procarbazine

Answer

Mesna

Question 8

Which monoclonal antibody is used in the treatment of head and neck cancer?

Accepted Answer

Pembrolizumab

Answer

Trastuzumab

Answer

Rituximab

Answer

Ocralizumab

Question 9

Maintenance of high urinary pH is important during methotrexate treatment because:

Accepted Answer

Methotrexate is a weak acid

Answer

Bladder irritation is reduced

Answer

It decreases renal tubular secretion of methotrexate

Answer

Leucovorin toxicity is increased in a dehydrated patient

Question 10

Rituximab is a targeted antibody against which antigen?

Accepted Answer

CD 20

Answer

CD 22

Answer

CD 34

Answer

CD 55

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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