Anticancer Drugs — MCQs
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A 70-year-old male presented with lumps felt in the axilla. On examination, axillary lymphadenopathy was noted. Biopsy was planned with the following histopathological examination. No Reed-Sternberg cells were seen. Flow cytometry revealed CD15 and CD30 negative. Following the histopathological confirmation of the disease, the patient was started on a chemotherapy regimen. After a few days, the patient developed dysuria. Which drug could have been supplemented to prevent hemorrhagic cystitis associated with the chemotherapy?
Which of the following is an alkylating agent used in cancer treatment?
What is the most important target of action of chlorambucil?
Which of the following is not a known adverse effect of tamoxifen used in breast cancer treatment?
Which of the following is NOT a treatment option for acute lymphoblastic leukemia?
Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?
Imatinib primarily acts by inhibiting which specific target?
What is the mechanism of action of fulvestrant?
Hand foot syndrome is an adverse effect of what?
Which GnRH agonist is approved for advanced prostate cancer?
Anticancer Drugs Indian Medical PG Practice Questions and MCQs
Question 581: A 70-year-old male presented with lumps felt in the axilla. On examination, axillary lymphadenopathy was noted. Biopsy was planned with the following histopathological examination. No Reed-Sternberg cells were seen. Flow cytometry revealed CD15 and CD30 negative. Following the histopathological confirmation of the disease, the patient was started on a chemotherapy regimen. After a few days, the patient developed dysuria. Which drug could have been supplemented to prevent hemorrhagic cystitis associated with the chemotherapy?
- A. Acrolein
- B. Mesna (Correct Answer)
- C. Dexrazoxane
- D. Amifostine
Explanation: ***Mesna*** - **Mesna** (2-mercaptoethane sulfonate sodium) is a chemoprotective agent used to prevent **hemorrhagic cystitis** caused by **cyclophosphamide** and **ifosfamide**. - In this case, the patient with non-Hodgkin lymphoma (CD15/CD30 negative, no Reed-Sternberg cells) was likely treated with a **cyclophosphamide-containing regimen** such as **CHOP** or **R-CHOP**. - Mesna works by **detoxifying acrolein**, a nephrotoxic and urotoxic metabolite of cyclophosphamide, in the urinary tract, thereby preventing bladder mucosal damage. *Acrolein* - **Acrolein** is the **toxic metabolite** of cyclophosphamide and ifosfamide that causes damage to the bladder lining, leading to hemorrhagic cystitis. - It is not a drug but the substance that needs to be neutralized by mesna. *Dexrazoxane* - **Dexrazoxane** is a cardioprotective agent used to prevent **anthracycline-induced cardiotoxicity**, specifically from drugs like **doxorubicin**. - It chelates iron and reduces oxidative damage to cardiomyocytes but does not prevent hemorrhagic cystitis. *Amifostine* - **Amifostine** is a cytoprotective agent used to reduce **cisplatin-induced nephrotoxicity** and **xerostomia** in patients undergoing radiation therapy for head and neck cancer. - It is not indicated for the prevention of hemorrhagic cystitis.
Question 582: Which of the following is an alkylating agent used in cancer treatment?
- A. Actinomycin-D
- B. 5-Fluorouracil
- C. Chlorambucil (Correct Answer)
- D. Vincristine
Explanation: ***Chlorambucil*** - **Chlorambucil** is a classic example of an **alkylating agent** used in chemotherapy. - Alkylating agents work by forming **covalent bonds** with DNA, leading to DNA damage and ultimately cell death. - It is particularly used in chronic lymphocytic leukemia and lymphomas. *Actinomycin-D* - **Actinomycin-D** is an **antibiotic** that functions as an **intercalating agent**, inhibiting RNA synthesis. - It works by inserting itself between DNA base pairs, distorting the DNA structure and preventing transcription. *5-Fluorouracil* - **5-Fluorouracil (5-FU)** is an **antimetabolite**, specifically a pyrimidine analog. - It interferes with DNA synthesis by mimicking **uracil** and inhibiting **thymidylate synthase**. *Vincristine* - **Vincristine** is a **vinca alkaloid**, a type of **microtubule inhibitor**. - It prevents the formation of the **mitotic spindle**, thereby arresting cells in metaphase and inhibiting cell division.
Question 583: What is the most important target of action of chlorambucil?
- A. Myeloid tissue
- B. Neural tissue
- C. Skin
- D. Lymphoid tissue (Correct Answer)
Explanation: ***Lymphoid tissue*** - **Chlorambucil** is an **alkylating agent** primarily used in the treatment of various **lymphoproliferative disorders**. - Its main therapeutic effect is on rapidly proliferating cells, particularly those of **lymphoid origin**, such as in chronic lymphocytic leukemia (CLL) and other lymphomas. *Myeloid tissue* - While chlorambucil can have some effect on myeloid cells, it is not its primary or most important target; other drugs are more specifically used for **myeloproliferative disorders**. - Its use in conditions like chronic myeloid leukemia (CML) is limited and generally not first-line. *Neural tissue* - Chlorambucil is not primarily an agent targeting **neural tissue** and is not used in the treatment of neurological conditions. - It does not readily cross the **blood-brain barrier** to a significant extent, limiting its direct action on the central nervous system. *Skin* - Although some **lymphomas** can manifest with **cutaneous involvement**, chlorambucil's direct and most important target is not the skin itself but rather the underlying **lymphoid cells**. - It is not a primary treatment for general skin conditions or non-lymphomatous skin cancers.
Question 584: Which of the following is not a known adverse effect of tamoxifen used in breast cancer treatment?
- A. Nausea and vomiting
- B. Endometrial carcinoma
- C. Carcinoma in the contralateral breast (Correct Answer)
- D. Cataract
Explanation: ***Carcinoma in the contralateral breast*** - Tamoxifen, a **selective estrogen receptor modulator (SERM)**, actually **reduces the risk** of new primary breast cancer in the contralateral breast. - This protective effect is one of the significant benefits of tamoxifen in high-risk women and those with a history of breast cancer. *Nausea and vomiting* - While tamoxifen is generally well-tolerated, **gastrointestinal side effects** like nausea and vomiting can occur, though typically mild compared to chemotherapy. - These side effects are often manageable and tend to diminish over time. *Endometrial carcinoma* - Tamoxifen acts as an **estrogen agonist** in the uterus, increasing the risk of **endometrial hyperplasia** and **endometrial carcinoma**. - This is a significant, well-documented adverse effect requiring regular monitoring, especially in postmenopausal women. *Cataract* - Tamoxifen has been linked to an increased risk of developing **cataracts**, particularly in long-term users. - The mechanism is not fully understood, but it is considered a known ocular side effect.
Question 585: Which of the following is NOT a treatment option for acute lymphoblastic leukemia?
- A. L-asparaginase
- B. Vincristine
- C. Prednisolone
- D. Rituximab (Correct Answer)
Explanation: ***Rituximab*** - **Rituximab** is a monoclonal antibody targeting the **CD20 antigen** found on B-lymphocytes, commonly used in **B-cell non-Hodgkin lymphoma** and **chronic lymphocytic leukemia** [1]. - **Acute lymphoblastic leukemia (ALL)** typically involves T-cell or pre-B-cell lineages and generally **does not express CD20**, making rituximab ineffective as a primary treatment [1].*Vincristine* - **Vincristine** is a **vinca alkaloid** that inhibits microtubule formation, crucial for cell division. - It is a cornerstone of **ALL induction and maintenance chemotherapy regimens**.*L-asparaginase* - **L-asparaginase** depletes asparagine, an essential amino acid for leukemic cells that cannot synthesize it themselves. - It is a vital component of **ALL treatment protocols**, particularly in pediatric ALL.*Prednisolone* - **Prednisolone** is a corticosteroid that induces apoptosis in lymphoid cells. - It is an important agent in the **induction phase of ALL treatment** and also used for supportive care to manage symptoms.
Question 586: Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?
- A. Adriamycin (Correct Answer)
- B. Methotrexate
- C. Cisplatin
- D. Daunorubicin
Explanation: ***Adriamycin*** - **Adriamycin** (doxorubicin) is an **anthracycline antibiotic** and is recognized as the most effective single agent for treating **leiomyosarcoma**. - It works by intercalating DNA and inhibiting macromolecular biosynthesis, leading to cell death in rapidly dividing cancer cells. *Daunorubicin* - While also an **anthracycline antibiotic**, **daunorubicin** is primarily used in the treatment of **leukemias**, such as acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL), rather than soft tissue sarcomas. - Its efficacy against solid tumors like leiomyosarcoma is significantly lower compared to doxorubicin. *Methotrexate* - **Methotrexate** is an **antifolate agent** commonly used in various cancers like **leukemia**, **lymphoma**, and **osteosarcoma**, as well as autoimmune diseases. - It is not considered a primary or highly active agent in the treatment of leiomyosarcoma. *Cisplatin* - **Cisplatin** is a **platinum-based chemotherapy drug** primarily used for **epithelial cancers** such as ovarian, testicular, bladder, and lung cancers. - It has limited activity as a single agent in the treatment of leiomyosarcoma.
Question 587: Imatinib primarily acts by inhibiting which specific target?
- A. Tyrosine Kinase
- B. PDGFR
- C. BCR–ABL tyrosine kinase (Correct Answer)
- D. None of the options
Explanation: ***BCR–ABL tyrosine kinase*** - Imatinib mesylate is a **specific inhibitor** of the **BCR–ABL tyrosine kinase**, which is the constitutively active oncoprotein found in **chronic myeloid leukemia (CML)**. - Its action involves binding to the ATP-binding site of the kinase domain, thus preventing the **phosphorylation** of downstream substrates required for cell proliferation and survival. *Tyrosine Kinase* - While Imatinib is a **tyrosine kinase inhibitor**, this option is too general as there are many different tyrosine kinases. - The question asks for the **specific target** of Imatinib, which is the BCR-ABL fusion protein's tyrosine kinase activity. *PDGFR* - Imatinib does inhibit **PDGFR (Platelet-Derived Growth Factor Receptor)** tyrosine kinases, which is relevant in some other conditions like gastrointestinal stromal tumors. - However, its primary and most historically significant target, especially in the context of CML that this class of question usually refers to, is the **BCR-ABL fusion protein**. *None of the options* - This option is incorrect because **BCR–ABL tyrosine kinase** is the correct and specific target. - Imatinib's designation as a **tyrosine kinase inhibitor** is due to its action on this specific enzyme.
Question 588: What is the mechanism of action of fulvestrant?
- A. Selective estrogen agonist
- B. Selective estrogen receptor modulator
- C. Selective estrogen receptor upregulator
- D. Selective estrogen receptor downregulator (Correct Answer)
Explanation: ***Selective estrogen receptor downregulator*** - Fulvestrant is classified as a **selective estrogen receptor downregulator (SERD)**. It binds to the estrogen receptor (ER) and promotes its degradation. - This effectively reduces the total number of ERs in the cell nucleus, leading to a profound anti-estrogenic effect without agonist activity. *Selective estrogen agonist* - An estrogen agonist would **activate estrogen receptors**, mimicking the effects of estrogen, which is not the therapeutic goal of fulvestrant in hormone-sensitive cancers. - Such a drug would promote tumor growth in estrogen-sensitive breast cancers. *Selective estrogen receptor modulator* - A selective estrogen receptor modulator (SERM) exhibits **tissue-specific agonist and antagonist effects** (e.g., tamoxifen acts as an antagonist in breast tissue but an agonist in bone). - Fulvestrant, in contrast, is a pure antagonist with no agonist activity and causes receptor degradation. *Selective estrogen receptor upregulator* - An upregulator would **increase the number of estrogen receptors**, potentially making cancer cells more sensitive to estrogen and promoting growth. - This mechanism is contrary to the therapeutic action of fulvestrant, which aims to reduce ER signaling.
Question 589: Hand foot syndrome is an adverse effect of what?
- A. Bleomycin
- B. Etoposide
- C. Actinomycin D
- D. 5-Fluorouracil (Correct Answer)
Explanation: ***5-Fluorouracil*** - **Hand-foot syndrome** (**palmar-plantar erythrodysesthesia**) is a common and dose-limiting side effect of 5-Fluorouracil and its prodrug, capecitabine. - It presents with **redness**, **swelling**, **pain**, and **desquamation** of the palms and soles. *Bleomycin* - The primary dose-limiting toxicity of bleomycin is **pulmonary fibrosis**, not hand-foot syndrome. - Other common toxicities include **hyperpigmentation** of the skin and mucocutaneous reactions, but not typically severe palmar-plantar changes. *Etoposide* - Etoposide is associated with adverse effects like **myelosuppression** (leukopenia, thrombocytopenia) and **alopecia**. - While skin reactions can occur, **hand-foot syndrome** is not a characteristic or common side effect of etoposide. *Actinomycin D* - Actinomycin D (dactinomycin) is known for causing **myelosuppression**, **nausea**, **vomiting**, and **mucositis**. - It can also cause **radiation recall phenomenon**, but not typically hand-foot syndrome as a primary or common adverse effect.
Question 590: Which GnRH agonist is approved for advanced prostate cancer?
- A. Abarelix
- B. Cetrorelix
- C. Goserelin (Correct Answer)
- D. Ganirelix
Explanation: ***Goserelin*** - **Goserelin** is a **gonadotropin-releasing hormone (GnRH) agonist** approved for the treatment of **advanced prostate cancer**. - It works by initially stimulating, then desensitizing, the pituitary gland to GnRH, leading to a profound decrease in **luteinizing hormone (LH)** and **follicle-stimulating hormone (FSH)**, which in turn reduces **testosterone production**. - This sustained suppression of testosterone is effective in managing hormone-sensitive prostate cancer. *Abarelix* - **Abarelix** is a **GnRH antagonist** (not an agonist), which directly blocks GnRH receptors. - While it was approved for advanced prostate cancer, it works through a different mechanism (antagonism vs agonism) and was later withdrawn from the market. - It is not a GnRH agonist. *Cetrorelix* - **Cetrorelix** is a **GnRH antagonist** (not an agonist) primarily used in **assisted reproductive technology (ART)** to prevent premature ovulation. - It is not approved for the treatment of prostate cancer. *Ganirelix* - **Ganirelix** is a **GnRH antagonist** (not an agonist) also used in **assisted reproductive technology (ART)** to prevent premature LH surges. - It is not approved for the treatment of prostate cancer.
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
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