Anticancer Drugs Practice Questions

Q: Which GnRH agonist is approved for advanced prostate cancer?

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approved for advanced prostate cancer, it works through a different mechanism (antagonism vs agonism) and was later withdrawn from the market.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

Q: What is Abraxane?

Albumin-bound formulation of paclitaxel. ***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.

Q: Which of the following is not an alkylating agent?

Cladribine. ***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.

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

Busulfan. ***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.

Q: Denileukin diftitox binds to which receptor?

IL-2 receptor. ***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.

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

Doxorubicin. ***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.

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

Abciximab. ***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**.

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

Carcinoma in contralateral breast. ***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.

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

Capecitabine. ***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.

Q: Which of the following can be given orally?

Cyclophosphamide. ***Cyclophosphamide*** - **Cyclophosphamide** is an **alkylating agent** that can be administered both **orally and intravenously**. - It has good **oral bioavailability** (>75%) and is commonly given orally in many chemotherapy regimens and immunosuppressive protocols. - Oral formulation is particularly useful for maintenance therapy and chronic administration. *Actinomycin D* - **Actinomycin D** (dactinomycin) is an **intravenous** antineoplastic agent. - It is a **peptide-containing antibiotic** that intercalates into DNA, and its oral bioavailability is very poor. *Cytosine arabinoside* - **Cytosine arabinoside** (cytarabine) is primarily administered **intravenously** or **subcutaneously**. - It has a high first-pass metabolism when given orally, resulting in very **low oral bioavailability**. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** that is predominantly given **intravenously**. - It has poor oral bioavailability due to extensive **first-pass metabolism** and is therefore not administered orally.

Question 1

Which GnRH agonist is approved for advanced prostate cancer?

Accepted Answer

Goserelin

Answer

Abarelix

Answer

Cetrorelix

Answer

Ganirelix

Question 2

What is Abraxane?

Accepted Answer

Albumin-bound formulation of paclitaxel

Answer

Globulin-bound formulation of docetaxel

Answer

Albumin-bound formulation of docetaxel

Answer

Globulin-bound formulation of paclitaxel

Question 3

Which of the following is not an alkylating agent?

Accepted Answer

Cladribine

Answer

Cyclophosphamide

Answer

Melphalan

Answer

Busulfan

Question 4

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

Accepted Answer

Busulfan

Answer

Mercaptopurine

Answer

Methotrexate

Answer

Cyclophosphamide

Question 5

Denileukin diftitox binds to which receptor?

Accepted Answer

IL-2 receptor

Answer

IL-1 receptor

Answer

IL-4 receptor

Answer

IL-5 receptor

Question 6

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

Accepted Answer

Doxorubicin

Answer

5-Fluorouracil

Answer

Methotrexate

Answer

Vinblastine

Question 7

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

Accepted Answer

Abciximab

Answer

Adalimumab

Answer

Infliximab

Answer

Etanercept

Question 8

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

Accepted Answer

Carcinoma in contralateral breast

Answer

Endometrial carcinoma

Answer

Cataract

Answer

Thromboembolism

Question 9

Which of the following chemotherapeutic agents can be administered orally?

Accepted Answer

Capecitabine

Answer

Actinomycin D

Answer

Doxorubicin

Answer

Cytarabine

Question 10

Which of the following can be given orally?

Accepted Answer

Cyclophosphamide

Answer

Actinomycin D

Answer

Cytosine arabinoside

Answer

Doxorubicin

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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