Anticancer Drugs Practice Questions

Q: Which of the following is used to treat hormone-responsive breast cancer?

Tamoxifen. ***Tamoxifen*** - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that acts as an **estrogen antagonist** in breast tissue, thereby blocking estrogen's proliferative effects on breast cancer cells. - It is a cornerstone treatment for **hormone-responsive (estrogen receptor-positive, ER+) breast cancer**, both in early and advanced stages, and can also be used for prevention in high-risk individuals. *Cyproterone acetate* - **Cyproterone acetate** is an **anti-androgen** with progestational activity, primarily used in conditions like **hirsutism**, prostate cancer, and severe acne. - While it has hormonal activity, it is not a primary therapeutic agent for **hormone-responsive breast cancer**. *Clomiphene citrate* - **Clomiphene citrate** is an **estrogen receptor modulator** used to induce ovulation in women who are anovulatory or oligo-ovulatory. - It works by blocking estrogen receptors in the hypothalamus, leading to increased release of **gonadotropins**, and is not used in breast cancer treatment. *Diethylstibestrol* - **Diethylstilbestrol (DES)** is a **synthetic non-steroidal estrogen** that was historically used for various conditions, including preventing miscarriage, but was later found to have significant adverse effects and teratogenic risks. - It was used as a treatment for advanced prostate cancer and, in very specific circumstances, even for breast cancer in postmenopausal women, but it is **not a current first-line therapy** for hormone-responsive breast cancer due to its toxicity and the availability of safer, more effective drugs.

Q: 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?

Mesna. ***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.

Q: Which of the following is an alkylating agent used in cancer treatment?

Chlorambucil. ***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.

Q: Which of the following is not a known adverse effect of tamoxifen used in breast cancer treatment?

Carcinoma in the contralateral breast. ***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.

Q: What is the most important target of action of chlorambucil?

Lymphoid tissue. ***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.

Q: Which of the following is NOT a treatment option for acute lymphoblastic leukemia?

Rituximab. ***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.

Q: Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?

Adriamycin. ***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.

Q: Imatinib primarily acts by inhibiting which specific target?

BCR–ABL tyrosine kinase. ***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.

Q: What is the mechanism of action of fulvestrant?

Selective estrogen receptor downregulator. ***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.

Q: Hand foot syndrome is an adverse effect of what?

5-Fluorouracil. ***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 1

Which of the following is used to treat hormone-responsive breast cancer?

Accepted Answer

Tamoxifen

Answer

Clomiphene citrate

Answer

Diethylstibestrol

Answer

Cyproterone acetate

Question 2

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?

Accepted Answer

Mesna

Answer

Acrolein

Answer

Dexrazoxane

Answer

Amifostine

Question 3

Which of the following is an alkylating agent used in cancer treatment?

Accepted Answer

Chlorambucil

Answer

Actinomycin-D

Answer

5-Fluorouracil

Answer

Vincristine

Question 4

Which of the following is not a known adverse effect of tamoxifen used in breast cancer treatment?

Accepted Answer

Carcinoma in the contralateral breast

Answer

Nausea and vomiting

Answer

Endometrial carcinoma

Answer

Cataract

Question 5

What is the most important target of action of chlorambucil?

Accepted Answer

Lymphoid tissue

Answer

Myeloid tissue

Answer

Neural tissue

Answer

Skin

Question 6

Which of the following is NOT a treatment option for acute lymphoblastic leukemia?

Accepted Answer

Rituximab

Answer

L-asparaginase

Answer

Vincristine

Answer

Prednisolone

Question 7

Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?

Accepted Answer

Adriamycin

Answer

Methotrexate

Answer

Cisplatin

Answer

Daunorubicin

Question 8

Imatinib primarily acts by inhibiting which specific target?

Accepted Answer

BCR–ABL tyrosine kinase

Answer

Tyrosine Kinase

Answer

PDGFR

Answer

None of the options

Question 9

What is the mechanism of action of fulvestrant?

Accepted Answer

Selective estrogen receptor downregulator

Answer

Selective estrogen agonist

Answer

Selective estrogen receptor modulator

Answer

Selective estrogen receptor upregulator

Question 10

Hand foot syndrome is an adverse effect of what?

Accepted Answer

5-Fluorouracil

Answer

Bleomycin

Answer

Etoposide

Answer

Actinomycin D

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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