Anticancer Drugs — MCQs

Anticancer Drugs Indian Medical PG Practice Questions and MCQs

Question 591: 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was approved for advanced prostate cancer, it works through a different mechanism (antagonism vs agonism) and was later withdrawn from the market.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.

Question 592: What is Abraxane?

A. Globulin-bound formulation of docetaxel
B. Albumin-bound formulation of docetaxel
C. Globulin-bound formulation of paclitaxel
D. Albumin-bound formulation of paclitaxel (Correct Answer)

Explanation: ***Albumin-bound formulation of paclitaxel*** - **Abraxane** (nab-paclitaxel) is a formulation of **paclitaxel** bound to **albumin nanoparticles**. - This formulation eliminates the need for **Cremophor EL** (used in conventional paclitaxel), thereby avoiding severe **hypersensitivity reactions** and allowing higher doses. - It has improved tumor delivery through albumin-mediated transcytosis. *Globulin-bound formulation of docetaxel* - This is incorrect on **both counts**: Abraxane contains **paclitaxel** (not docetaxel) and uses **albumin** (not globulin). - Docetaxel is formulated with **polysorbate 80**, not with protein carriers. *Albumin-bound formulation of docetaxel* - While the **albumin-bound** concept is correct, the drug is wrong. - Abraxane specifically contains **paclitaxel**, not docetaxel. - Docetaxel does not have an albumin-bound formulation. *Globulin-bound formulation of paclitaxel* - While **paclitaxel** is correct, the carrier protein is wrong. - Abraxane uses **albumin nanoparticles** as the carrier, not globulin. - No globulin-bound taxane formulations are currently available.

Question 593: Which of the following is not an alkylating agent?

A. Cyclophosphamide
B. Melphalan
C. Busulfan
D. Cladribine (Correct Answer)

Explanation: ***Cladribine*** - **Cladribine** is a **purine analog** (antimetabolite), not an alkylating agent, that inhibits DNA synthesis and repair. - It is primarily used in the treatment of **hairy cell leukemia** and certain lymphomas. *Melphalan* - **Melphalan** is an **alkylating agent** derived from nitrogen mustard, used in multiple myeloma and ovarian cancer. - It works by irreversibly binding to DNA, causing **cross-links** and inhibiting DNA replication. *Cyclophosphamide* - **Cyclophosphamide** is a **nitrogen mustard alkylating agent** that forms DNA cross-links and is a prodrug requiring hepatic activation. - It is widely used in various cancers and as an **immunosuppressant**. *Busulfan* - **Busulfan** is an **alkylating agent** specifically a **sulfonate ester**, which cross-links DNA and RNA. - It's mainly used in **myeloproliferative disorders** and as a conditioning agent before stem cell transplantation.

Question 594: Which of the following anticancer drugs is MOST characteristically associated with pulmonary fibrosis?

A. Mercaptopurine
B. Busulfan (Correct Answer)
C. Methotrexate
D. Cyclophosphamide

Explanation: ***Busulfan*** - **Busulfan** is an **alkylating agent** that is **MOST characteristically** associated with **pulmonary fibrosis** among the given options. - Causes **"Busulfan lung"** - a distinctive chronic interstitial pulmonary fibrosis that can occur in **4-6% of patients**. - Typically develops **insidiously** after prolonged therapy with **cumulative dose-related toxicity**. - Presents with **progressive dyspnea, dry cough**, and restrictive lung pattern on pulmonary function tests. - This is a **classic association** emphasized in medical examinations. *Cyclophosphamide* - **Cyclophosphamide** can also cause **pulmonary fibrosis**, particularly with high cumulative doses. - However, it is **less characteristically** associated with this complication compared to busulfan. - Pulmonary toxicity is more **variable and less predictable** in severity. *Methotrexate* - **Methotrexate** can cause lung toxicity, most commonly as **acute methotrexate pneumonitis** (hypersensitivity reaction). - While **chronic fibrosis can occur**, it is less frequent than the acute inflammatory process. - Not the **most characteristic** association for pulmonary fibrosis. *Mercaptopurine* - **Mercaptopurine** is an **antimetabolite** primarily associated with **hepatotoxicity** and **myelosuppression**. - **Not associated** with pulmonary fibrosis.

Question 595: Denileukin diftitox binds to which receptor?

A. IL-1 receptor
B. IL-2 receptor (Correct Answer)
C. IL-4 receptor
D. IL-5 receptor

Explanation: ***IL-2 receptor*** - Denileukin diftitox is a **fusion protein** consisting of human **interleukin-2 (IL-2)** and diphtheria toxin fragments. - Its mechanism of action relies on binding to the **high-affinity IL-2 receptor (CD25)** found on the surface of some cancer cells, particularly those in cutaneous T-cell lymphoma, delivering the toxin for cell apoptosis. *IL-1 receptor* - The **IL-1 receptor** mediates the effects of interleukin-1, a pro-inflammatory cytokine, and its binding is not a mechanism for denileukin diftitox. - Denileukin diftitox is specifically designed to target the IL-2 pathway, not the IL-1 pathway, for cancer treatment. *IL-4 receptor* - The **IL-4 receptor** is involved in allergic responses and immune regulation, primarily binding interleukin-4. - Denileukin diftitox is engineered to exploit the IL-2 signaling pathway for therapeutic effect, not the IL-4 pathway. *IL-5 receptor* - The **IL-5 receptor** is important for the development and function of eosinophils, mediating the effects of interleukin-5. - Denileukin diftitox's therapeutic utility is linked to its specific interaction with the IL-2 receptor, which is distinct from the IL-5 receptor.

Question 596: Which drug has been used in the treatment of anaplastic thyroid carcinoma despite limited efficacy?

A. Doxorubicin (Correct Answer)
B. 5-Fluorouracil
C. Methotrexate
D. Vinblastine

Explanation: ***Doxorubicin*** - While anaplastic thyroid carcinoma is often **highly resistant to chemotherapy**, doxorubicin has shown some limited efficacy in studies, making it one of the systemic agents sometimes used to attempt to control disease progression. - It works as an **anthracycline antibiotic** that intercalates DNA, inhibiting macromolecular biosynthesis and causing cell death. *5-Fluorouracil* - **5-FU** is primarily used in the treatment of various **gastrointestinal cancers** (e.g., colorectal, gastric, pancreatic) and some breast cancers. [1] - Its mechanism involves inhibiting **thymidylate synthase**, thereby disrupting DNA synthesis; however, it has minimal activity against anaplastic thyroid carcinoma. [1] *Methotrexate* - **Methotrexate** is a **folate antagonist** mainly used in the treatment of leukemia, lymphomas, and autoimmune diseases like rheumatoid arthritis and psoriasis. [2] - It is not considered a standard or effective treatment for anaplastic thyroid carcinoma. [2] *Vinblastine* - **Vinblastine** is a **vinca alkaloid** that inhibits microtubule formation, arresting cells in metaphase; it is commonly used in Hodgkin lymphoma, non-small cell lung cancer, and testicular cancer. - It has limited to no role in the treatment of anaplastic thyroid carcinoma.

Question 597: All of the following are tumor necrosis factor-blocking agents, except:

A. Adalimumab
B. Infliximab
C. Abciximab (Correct Answer)
D. Etanercept

Explanation: ***Abciximab*** - **Abciximab** is a **glycoprotein IIb/IIIa receptor antagonist** used as an antiplatelet agent, not a TNF-blocking agent. - It works by preventing the binding of **fibrinogen**, **von Willebrand factor**, and other adhesive proteins to the glycoprotein IIb/IIIa receptor on platelets, thereby inhibiting platelet aggregation. *Adalimumab* - **Adalimumab** is a **monoclonal antibody** that directly binds to **tumor necrosis factor-alpha (TNF-α)**, preventing it from binding to its receptors. - It is used in conditions like **rheumatoid arthritis**, **psoriatic arthritis**, and **Crohn's disease**. *Etanercept* - **Etanercept** is a **fusion protein** that acts as a **decoy receptor** for **TNF-α**, binding to it and rendering it inactive. - It is also indicated for similar autoimmune and inflammatory conditions as adalimumab. *Infliximab* - **Infliximab** is a **chimeric monoclonal antibody** that binds with **high affinity** to both the **soluble and transmembrane forms of TNF-α**. - It neutralizes TNF-α's biological activity and is used in the treatment of diseases such as **Crohn's disease**, **ulcerative colitis**, and **rheumatoid arthritis**.

Question 598: Use of tamoxifen for breast cancer can cause all of the following adverse effects, except which of the following?

A. Endometrial carcinoma
B. Cataract
C. Thromboembolism
D. Carcinoma in contralateral breast (Correct Answer)

Explanation: ***Carcinoma in contralateral breast*** - Tamoxifen is an **estrogen receptor modulator** used in breast cancer treatment, and it reduces the risk of new primary breast cancers, including in the contralateral breast. - Its mechanism of action involves **blocking estrogen effects** in breast tissue, thus preventing estrogen-dependent tumor growth and recurrence. *Thromboembolism* - Tamoxifen has **estrogenic effects** in some tissues, increasing the risk of thrombotic events like **deep vein thrombosis** and **pulmonary embolism**. - This adverse effect is a significant concern, particularly in older patients or those with pre-existing risk factors for clotting. *Endometrial carcinoma* - Tamoxifen acts as a **partial estrogen agonist** in the uterus, stimulating endometrial proliferation. - This proliferative effect can lead to an increased risk of developing **endometrial hyperplasia** and **carcinoma**. *Cataract* - Tamoxifen use has been associated with an increased risk of **cataract formation** and other ocular toxicities. - Patients undergoing tamoxifen therapy should have **regular ophthalmological examinations** to monitor for these potential side effects.

Question 599: Which of the following chemotherapeutic agents can be administered orally?

A. Actinomycin D
B. Doxorubicin
C. Capecitabine (Correct Answer)
D. Cytarabine

Explanation: ***Capecitabine*** - **Capecitabine** is a **prodrug** that is converted into **5-fluorouracil (5-FU)** in the body, which then exerts its cytotoxic effect. - Its oral bioavailability allows for **convenient outpatient administration**, unlike many other chemotherapeutic agents [1].*Cytarabine* - **Cytarabine** (Ara-C) is primarily administered intravenously or subcutaneously due to its **poor oral absorption** and rapid deamination in the gastrointestinal tract. - It is a **pyrimidine analog** mainly used in acute myeloid leukemia and lymphomas.*Actinomycin D* - **Actinomycin D** (dactinomycin) is a powerful antitumor antibiotic derived from *Streptomyces parvullus* and is given via **intravenous injection**. - Its cytotoxic effects stem from its ability to **intercalate DNA** and inhibit RNA synthesis, which necessitates parenteral administration.*Doxorubicin* - **Doxorubicin**, an **anthracycline antibiotic**, is administered intravenously because it has **poor oral bioavailability** and is extensively metabolized if taken orally. - It is known for its **cardiotoxicity** and is used in a wide range of cancers, including breast cancer, lymphomas, and sarcomas.

Question 600: Tamoxifen is primarily indicated for reducing the risk of which type of cancer?

A. Breast (Correct Answer)
B. Endometrium
C. Ovary
D. All of the options

Explanation: ***Breast***- **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** specifically used in **estrogen receptor-positive (ER+) breast cancer** [1, 2].It acts as an **estrogen antagonist** in breast tissue, thereby **reducing breast cancer recurrence and risk** [1].This is its **primary and most important clinical indication** [1, 2].*Endometrium*- While tamoxifen is effective against breast cancer, it acts as an **estrogen agonist** in the endometrial tissue [1].This **estrogenic effect** paradoxically **increases the risk** of developing **endometrial cancer** as a side effect [1].Therefore, it is **not indicated** for endometrial cancer prevention [1].*Ovary*- Tamoxifen has **no primary indication** for the prevention or treatment of **ovarian cancer**.Its mechanism of action is not relevant to the typical pathogenesis of ovarian malignancies.*All of the options*- This option is incorrect because tamoxifen **does not reduce the risk of all listed cancers**.It specifically **increases** the risk of endometrial cancer rather than reducing it [1].Its beneficial effects are primarily observed in **estrogen receptor-positive breast cancer** only [1, 2].

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

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Immunotherapy

Practice Questions

Management of Chemotherapy Side Effects

Practice Questions

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