Anticancer Drugs — MCQs

Anticancer Drugs Indian Medical PG Practice Questions and MCQs

Question 41: Cerebellar toxicity is commonly associated with which of the following anticancer drugs?

A. Cisplatin
B. Cytarabine (Correct Answer)
C. Bleomycin
D. Actinomycin D

Explanation: **Explanation:** **Cytarabine (Ara-C)** is the correct answer. It is a pyrimidine antimetabolite that inhibits DNA polymerase. **Cerebellar toxicity** (manifesting as ataxia, dysarthria, and nystagmus) is a classic, dose-limiting side effect specifically associated with **High-Dose Cytarabine (HiDAC)** therapy, often used in acute myeloid leukemia (AML). The mechanism involves the drug’s ability to cross the blood-brain barrier and cause direct damage to Purkinje cells in the cerebellum. **Analysis of Incorrect Options:** * **A. Cisplatin:** Primarily known for its "3 Os": **O**totoxicity (tinnitus/hearing loss), **O**nephrotoxicity (renal tubular damage), and severe **O**moting (highly emetogenic). It also causes peripheral neuropathy (glove-and-stocking anesthesia) rather than cerebellar symptoms. * **C. Bleomycin:** Its most dreaded complication is **Pulmonary Fibrosis**. It is also known for causing skin hyperpigmentation (flagellate dermatitis) but lacks significant neurotoxicity. * **D. Actinomycin D:** Primarily associated with bone marrow suppression and "radiation recall" phenomenon. It does not typically cause cerebellar dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Cytarabine:** Apart from cerebellar ataxia, it causes **conjunctivitis** (prophylactic steroid eye drops are mandatory with high doses) and "Ara-C syndrome" (fever, rash, bone pain). * **5-Fluorouracil (5-FU):** Another pyrimidine analog that can also cause cerebellar ataxia, though it is more frequently tested for **Hand-Foot Syndrome**. * **Vincristine:** Most common anticancer drug causing **peripheral neuropathy** and paralytic ileus (autonomic neuropathy). * **Paclitaxel:** Known for peripheral neuropathy and hypersensitivity reactions.

Question 42: Panitumumab is used for which of the following conditions?

A. Multiple Sclerosis
B. Osmotic diarrhea
C. Ascites
D. Colorectal Carcinoma (Correct Answer)

Explanation: **Explanation:** **Panitumumab** is a recombinant, fully humanized monoclonal antibody that targets the **Epidermal Growth Factor Receptor (EGFR)**. By binding to the extracellular domain of EGFR, it inhibits downstream signaling pathways (like RAS-RAF-MAPK) that promote cell proliferation and survival. * **Why Colorectal Carcinoma is correct:** Panitumumab is specifically indicated for the treatment of **metastatic Colorectal Carcinoma (mCRC)**. It is used in patients whose tumors express wild-type **KRAS** (non-mutated). If the KRAS gene is mutated, the signaling pathway remains "permanently on" regardless of EGFR inhibition, making the drug ineffective. **Analysis of Incorrect Options:** * **Multiple Sclerosis:** This is an autoimmune demyelinating disease. Drugs used here include Ocrelizumab (anti-CD20) or Natalizumab (anti-alpha-4 integrin), not EGFR inhibitors. * **Osmotic Diarrhea:** This is a physiological state caused by poorly absorbed solutes (e.g., lactulose or magnesium salts). It is not a clinical indication for monoclonal antibodies. * **Ascites:** This is a clinical sign of portal hypertension or malignancy. While treating the underlying cancer might reduce ascites, Panitumumab is not a direct treatment for the fluid accumulation itself. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** EGFR (ErbB1) Inhibitor. * **Genetic Testing:** Always check for **KRAS/NRAS mutations** before prescribing. It only works in **Wild-type** cases. * **Key Side Effect:** **Acneiform skin rash** (the severity of the rash often correlates with a better therapeutic response). * **Comparison:** **Cetuximab** is another EGFR inhibitor used for mCRC, but it is a chimeric antibody, whereas Panitumumab is fully humanized (lower risk of infusion reactions).

Question 43: Flutamide is used in which type of cancer?

A. Cervix
B. Prostate (Correct Answer)
C. Kidneys
D. Liver

Explanation: **Explanation:** **Flutamide** is a non-steroidal, competitive **androgen receptor antagonist**. Its primary mechanism involves blocking the binding of dihydrotestosterone (DHT) and testosterone to their receptors in target tissues. Since prostate cancer cells are typically androgen-dependent for growth and proliferation, blocking these receptors inhibits tumor progression. * **Why Prostate is Correct:** Prostate cancer is the classic indication for anti-androgens. Flutamide is frequently used in "Combined Androgen Blockade" (CAB) alongside GnRH agonists (like Leuprolide). This combination prevents the "testosterone flare" (a transient rise in testosterone) that occurs when GnRH agonists are first initiated. * **Why other options are incorrect:** * **Cervix:** Cervical cancer is primarily associated with HPV infection and is treated with surgery, radiation, or platinum-based chemotherapy (e.g., Cisplatin), not hormonal therapy. * **Kidneys:** Renal Cell Carcinoma (RCC) is managed with surgery, tyrosine kinase inhibitors (e.g., Sunitinib), or immunotherapy. * **Liver:** Hepatocellular carcinoma is treated with multi-kinase inhibitors like Sorafenib. **High-Yield Clinical Pearls for NEET-PG:** 1. **Side Effects:** The most characteristic side effect of Flutamide is **gynecomastia** (due to increased peripheral conversion of androgens to estrogen) and potential **hepatotoxicity** (requires monitoring of LFTs). 2. **Bicalutamide:** A newer congener of Flutamide, preferred nowadays due to its once-daily dosing and lower risk of hepatotoxicity. 3. **Cyproterone Acetate:** Another anti-androgen, but unlike Flutamide, it also has progestational activity and inhibits LH secretion.

Question 44: Methotrexate is used in all of the following conditions except?

A. Sickle cell anemia (Correct Answer)
B. Psoriasis
C. Rheumatoid arthritis
D. Ankylosing spondylitis

Explanation: **Explanation:** **1. Why Sickle Cell Anemia is the Correct Answer:** Methotrexate is a **folate antagonist** that inhibits the enzyme **dihydrofolate reductase (DHFR)**, leading to a decrease in DNA synthesis. In **Sickle Cell Anemia**, the drug of choice is **Hydroxyurea**, which works by increasing the levels of Fetal Hemoglobin (HbF). Methotrexate has no therapeutic role in sickle cell disease; in fact, its bone marrow suppressive effects could worsen the anemia. **2. Why the other options are incorrect:** * **Psoriasis:** Methotrexate is a first-line systemic therapy for severe psoriasis. It acts by inhibiting the rapid proliferation of epidermal keratinocytes and providing systemic anti-inflammatory effects. * **Rheumatoid Arthritis (RA):** It is the **"Gold Standard" Disease-Modifying Antirheumatic Drug (DMARD)**. It acts as an immunosuppressant by increasing extracellular adenosine, which inhibits T-cell activation and inflammation. * **Ankylosing Spondylitis:** While TNF-inhibitors are preferred for axial disease, Methotrexate is frequently used as a DMARD to manage peripheral joint involvement in patients with spondyloarthropathies. **Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive inhibition of DHFR. * **Rescue Therapy:** **Leucovorin (Folinic acid)** is used to "rescue" normal cells from methotrexate toxicity (it bypasses the blocked DHFR enzyme). * **Toxicity:** Most common side effect is mucosal ulceration (stomatitis). Most serious are hepatotoxicity (cirrhosis) and pulmonary fibrosis. * **Contraindication:** It is highly **teratogenic** (causes neural tube defects) and contraindicated in pregnancy. * **Other Uses:** Ectopic pregnancy, Choriocarcinoma, and Acute Lymphoblastic Leukemia (ALL).

Question 45: A 65-year-old female with ovarian cancer is being treated with cisplatin-based chemotherapy. All of the following are used to limit the toxicity of cisplatin except?

A. N-acetylcysteine (Correct Answer)
B. Slow rate of infusion
C. Chloride diuresis
D. Amifostine

Explanation: **Explanation:** The correct answer is **A. N-acetylcysteine**. Cisplatin is a potent platinum-based alkylating agent known for its significant dose-limiting **nephrotoxicity**. N-acetylcysteine (NAC) is primarily used as an antidote for acetaminophen (paracetamol) toxicity and as a mucolytic agent; it has no established clinical role in preventing cisplatin-induced nephrotoxicity. **Why the other options are incorrect (Mechanisms of Protection):** * **Chloride Diuresis:** This is the most critical preventive measure. Cisplatin is less toxic in high-chloride environments. Maintaining high chloride concentration in the renal tubules (via 0.9% Normal Saline) keeps the drug in its non-reactive, neutral form, preventing it from converting into the toxic aquated species that damages tubular cells. * **Slow rate of infusion:** Administering cisplatin slowly (over several hours) reduces the peak plasma concentration, thereby decreasing the intensity of acute renal tubular damage. * **Amifostine:** This is a cytoprotective organic thiophosphate. It is a prodrug that is dephosphorylated by alkaline phosphatase (more active in normal tissues) to a free thiol that scavenges reactive metabolites of cisplatin, specifically reducing nephrotoxicity. **High-Yield Clinical Pearls for NEET-PG:** * **Cisplatin Toxicities:** Remember the mnemonic **"3 N's"**: **N**ephrotoxicity, **N**eurotoxicity (peripheral neuropathy), and **N**ausea/vomiting (highly emetogenic). It is also famously **Ototoxic**. * **Drug of Choice for Vomiting:** Palonosetron (5-HT3 antagonist) + Dexamethasone + Aprepitant (NK1 antagonist) is the standard regimen for cisplatin-induced emesis. * **Alternative:** **Carboplatin** is often preferred over cisplatin as it is less nephrotoxic and ototoxic, though it causes more myelosuppression (thrombocytopenia).

Question 46: Binimetinib was recently approved by the FDA for which condition?

A. Prostate cancer
B. Melanoma (Correct Answer)
C. Smallpox
D. Chickenpox

Explanation: **Explanation:** **Binimetinib** is a potent and selective oral inhibitor of **MEK1 and MEK2** (Mitogen-activated protein Kinase). These enzymes are key components of the MAPK/ERK pathway, which regulates cell proliferation and survival. In many cancers, particularly melanoma, this pathway is constitutively active due to mutations. 1. **Why Melanoma is Correct:** In 2018, the FDA approved the combination of **Binimetinib and Encorafenib** (a BRAF inhibitor) for the treatment of patients with unresectable or metastatic **melanoma** harboring a **BRAF V600E or V600K mutation**. Using a MEK inhibitor alongside a BRAF inhibitor helps delay the development of drug resistance and reduces specific side effects like cutaneous squamous cell carcinomas. 2. **Why Incorrect Options are Wrong:** * **Prostate Cancer:** Standard treatments include androgen deprivation therapy (e.g., Leuprolide), anti-androgens (e.g., Enzalutamide), or taxanes (e.g., Docetaxel). MEK inhibitors are not currently first-line FDA-approved treatments here. * **Smallpox & Chickenpox:** These are viral infections caused by Variola and Varicella-zoster viruses, respectively. They are treated with antivirals (e.g., Tecovirimat for smallpox; Acyclovir for chickenpox), not targeted antineoplastic kinase inhibitors. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Binimetinib = MEK 1/2 Inhibitor. * **The "Nib" Suffix:** Indicates a small-molecule kinase inhibitor. * **Combination Therapy:** Always remember the pair: **Encorafenib + Binimetinib**. (Similar to Dabrafenib + Trametinib or Vemurafenib + Cobimetinib). * **Side Effects:** Common toxicities include diarrhea, fatigue, and uniquely, **retinal pigment epithelial detachment (RPED)** and increased Creatine Phosphokinase (CPK).

Question 47: Which immunostimulant is used for the treatment of malignant melanoma?

A. Levamisole
B. BCG
C. Aldesleukin (Correct Answer)
D. Methotrexate

Explanation: **Explanation:** **Aldesleukin (Option C)** is a recombinant form of **Interleukin-2 (IL-2)**. It acts as an immunostimulant by promoting the proliferation and activation of T-cells and Natural Killer (NK) cells, enhancing the body’s immune response against tumor cells. It is specifically FDA-approved and clinically indicated for the treatment of **metastatic renal cell carcinoma** and **metastatic malignant melanoma**. **Analysis of Incorrect Options:** * **Levamisole (Option A):** Historically used as an adjuvant in colorectal cancer (with 5-FU) and for its anthelmintic properties. It is no longer a primary choice for melanoma. * **BCG (Option B):** While an immunostimulant, its primary oncological use is intravesical therapy for **superficial bladder cancer**. It is not the systemic treatment of choice for malignant melanoma. * **Methotrexate (Option D):** This is an antimetabolite (folic acid antagonist) and an **immunosuppressant/cytotoxic** drug, not an immunostimulant. **High-Yield Clinical Pearls for NEET-PG:** 1. **Capillary Leak Syndrome:** The most characteristic and life-threatening side effect of Aldesleukin (IL-2). It leads to hypotension, edema, and multiorgan failure. 2. **Other Melanoma Drugs:** Modern management also includes BRAF inhibitors (**Vemurafenib**) for BRAF V600E mutations and Immune Checkpoint Inhibitors like **Ipilimumab** (CTLA-4 inhibitor) and **Pembrolizumab** (PD-1 inhibitor). 3. **Interferon-alpha:** Another cytokine used in melanoma, primarily for adjuvant therapy in high-risk cases.

Question 48: Methotrexate is used for the management of all of the following conditions except?

A. Rheumatoid arthritis
B. Psoriasis
C. Sickle cell anemia (Correct Answer)
D. Organ transplantation

Explanation: **Explanation:** **Methotrexate (MTX)** is a folate antagonist that inhibits the enzyme **dihydrofolate reductase (DHFR)**. This inhibition prevents the conversion of dihydrofolate to tetrahydrofolate, leading to a deficiency in thymidylate and purine synthesis, which ultimately halts DNA synthesis and cell proliferation. **Why Sickle Cell Anemia is the Correct Answer:** Methotrexate has no role in the management of Sickle Cell Anemia. The drug of choice for reducing the frequency of painful crises in Sickle Cell Anemia is **Hydroxyurea**, which works by increasing the production of fetal hemoglobin (HbF). **Analysis of Other Options:** * **Rheumatoid Arthritis (RA):** MTX is the **"Anchor Drug"** and the first-line Disease-Modifying Antirheumatic Drug (DMARD) for RA. It acts via adenosine accumulation, which has potent anti-inflammatory effects. * **Psoriasis:** MTX is used in severe, recalcitrant psoriasis and psoriatic arthritis due to its ability to inhibit the rapid turnover of epidermal cells (keratinocytes). * **Organ Transplantation:** MTX is used as an immunosuppressant to prevent **Graft-versus-Host Disease (GVHD)** and organ rejection by suppressing T-cell activation and proliferation. **High-Yield Clinical Pearls for NEET-PG:** * **Rescue Therapy:** **Leucovorin (Folinic acid)** is used to "rescue" normal cells from MTX toxicity (Leucovorin Rescue). * **Toxicity:** The most common side effect is mucosal ulceration (stomatitis). Long-term use can lead to **hepatic fibrosis** and **pneumonitis**. * **Contraindication:** It is highly **teratogenic** (Category X) and must be avoided in pregnancy. * **Monitoring:** Periodic Liver Function Tests (LFTs) and Complete Blood Counts (CBC) are mandatory.

Question 49: Which of the following is an approved drug for prostate cancer?

A. Bicalutamide
B. Apalutamide (Correct Answer)
C. Ibalizumab
D. Ivacaftor

Explanation: **Explanation:** **Apalutamide** is a potent, second-generation **androgen receptor (AR) antagonist**. It works by binding directly to the ligand-binding domain of the AR, preventing androgen binding, nuclear translocation, and DNA binding. It is FDA-approved for the treatment of non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic castration-sensitive prostate cancer (mCSPC). **Analysis of Options:** * **Bicalutamide (Option A):** While this is a first-generation anti-androgen used in prostate cancer, the question asks for the "approved drug" in a context where modern oncology exams prioritize newer, high-potency agents. In clinical practice, second-generation agents like Apalutamide or Enzalutamide are preferred due to their superior efficacy and lack of partial agonist activity. * **Ibalizumab (Option C):** This is a **CD4-directed post-attachment inhibitor** used in the management of multidrug-resistant HIV-1 infection. It is a monoclonal antibody, not an anticancer drug. * **Ivacaftor (Option D):** This is a **CFTR potentiator** used in the treatment of Cystic Fibrosis (specifically for patients with the G551D mutation). **NEET-PG High-Yield Pearls:** * **Second-generation AR Antagonists:** Apalutamide, Enzalutamide, and Darolutamide. Unlike Bicalutamide, these do not exhibit agonist activity when AR is overexpressed. * **Side Effects of Apalutamide:** Notable for causing skin rash, hypothyroidism, and an increased risk of seizures (due to GABA-A inhibition). * **Mechanism of Prostate Cancer Drugs:** * GnRH Agonists (Leuprolide) – Initial flare, then down-regulation. * GnRH Antagonists (Degarelix) – No flare. * CYP17 Inhibitor (Abiraterone) – Blocks androgen synthesis.

Question 50: Which of the following is an anti-VEGF drug?

A. Adalimumab
B. Bevacizumab (Correct Answer)
C. Cetuximab
D. Daclizumab

Explanation: **Explanation:** **Bevacizumab** is a recombinant humanized monoclonal antibody that acts as a potent **anti-VEGF (Vascular Endothelial Growth Factor)** agent. It binds directly 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 required for growth and metastasis. It is clinically used in the treatment of metastatic colorectal cancer, renal cell carcinoma, and age-related macular degeneration (AMD). **Analysis of Incorrect Options:** * **Adalimumab:** A monoclonal antibody against **TNF-α** (Tumor Necrosis Factor-alpha). It is primarily used in chronic inflammatory conditions like Rheumatoid Arthritis, Psoriasis, and Crohn’s disease. * **Cetuximab:** A monoclonal antibody that targets the **EGFR** (Epidermal Growth Factor Receptor). It is used in the treatment of KRAS wild-type colorectal cancer and head and neck cancers. * **Daclizumab:** An antibody against the **IL-2 receptor (CD25)**. It was historically used to prevent renal transplant rejection and in multiple sclerosis (though largely withdrawn due to hepatic toxicity). **High-Yield Clinical Pearls for NEET-PG:** * **Adverse Effects of Bevacizumab:** The most characteristic side effects are **hypertension**, impaired wound healing, and gastrointestinal perforation. * **Suffix Trick:** Monoclonal antibodies ending in **"-umab"** are fully human, while **"-ximab"** are chimeric. * **Other Anti-VEGF agents:** **Ranibizumab** (fragment used for AMD) and **Aflibercept** (a "VEGF trap" fusion protein).

Practice by Chapter

Principles of Cancer Chemotherapy

Practice Questions

Alkylating Agents

Practice Questions

Antimetabolites

Practice Questions

Antitumor Antibiotics

Practice Questions

Plant Alkaloids

Practice Questions

Topoisomerase Inhibitors

Practice Questions

Hormonal Agents

Practice Questions

Targeted Therapy

Practice Questions

Immunotherapy

Practice Questions

Management of Chemotherapy Side Effects

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free