Anticancer Drugs Practice Questions

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

Breast. ***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].

Q: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

Cisplatin. ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.

Q: The use of which of the following helps in reducing the toxicity of doxorubicin to the heart?

Dexrazoxane. ***Dexrazoxane*** - **Dexrazoxane** is a **cardioprotective agent** that chelates intracellular iron, thereby reducing the formation of **free radicals** responsible for doxorubicin-induced cardiotoxicity. - It is specifically approved for reducing the incidence and severity of **cardiomyopathy** associated with doxorubicin use, particularly in patients who have received a high cumulative dose. *Amifostine* - **Amifostine** is a **cytoprotective agent** used to reduce the incidence of nephrotoxicity associated with platinum-based chemotherapy (e.g., cisplatin) and to reduce xerostomia in patients undergoing radiation therapy for head and neck cancer. - Its primary mechanism involves scavenging **free radicals** and detoxifying reactive metabolites in normal tissues, but it is not specifically indicated for doxorubicin-induced cardiotoxicity. *Carboplatin* - **Carboplatin** is a **platinum-based chemotherapy agent** similar to cisplatin, primarily used in the treatment of various cancers, including ovarian, lung, and head and neck cancers. - It causes myelosuppression and nephrotoxicity as major side effects but is a **chemotherapeutic drug itself**, not a protective agent against other chemotherapies. *Flucytosine* - **Flucytosine** is an **antifungal medication** used to treat severe systemic fungal infections, often in combination with amphotericin B. - Its mechanism involves interfering with fungal DNA and RNA synthesis, and it has no known role in mitigating the toxicity of doxorubicin.

Q: Anticancer drug causing syndrome of inappropriate antidiuretic hormone secretion (SIADH) as an adverse effect is:

Vincristine. ***Vincristine*** - Vincristine is a **vinca alkaloid** (microtubule inhibitor) that is **classically associated with SIADH** as a well-documented adverse effect. - The mechanism involves **neurotoxicity** affecting the hypothalamus or posterior pituitary, leading to **excessive ADH secretion**. - This results in **hyponatremia** with concentrated urine and is a high-yield association for medical exams. *Paclitaxel* - Paclitaxel is a **taxane** (microtubule stabilizer) with different adverse effect profile. - Primary adverse effects include **myelosuppression**, peripheral neuropathy, and hypersensitivity reactions. - **SIADH is not a characteristic adverse effect** of paclitaxel. *Dacarbazine* - Dacarbazine is an **alkylating agent** used primarily in melanoma and Hodgkin lymphoma. - Main adverse effects are **myelosuppression**, severe nausea/vomiting, and flu-like symptoms. - **SIADH is not associated** with dacarbazine use. *Cyclophosphamide* - Cyclophosphamide is an **alkylating agent** with well-known adverse effects including hemorrhagic cystitis and myelosuppression. - While cyclophosphamide can rarely cause SIADH, it is **not the classic association** tested in exams. - **Vincristine remains the prototype drug** for anticancer drug-induced SIADH in medical education.

Q: Estramustine is a combination of which two drugs?

Estradiol + Normustine. ***Estradiol + Normustine*** - **Estramustine** is a **chemotherapeutic agent** used in the treatment of **prostate cancer**. - It is a **conjugate molecule** combining **estradiol-17β** (a synthetic estrogen) with **normustine** (nor-mechlorethamine, a nitrogen mustard derivative). - The estrogen component targets the hormone-responsive prostate tissue, while the alkylating agent provides cytotoxic effects. *Estradiol + mechlorethamine* - While **normustine** (nor-mechlorethamine) is chemically related to **mechlorethamine**, estramustine specifically contains **normustine**, not mechlorethamine itself. - Normustine is a demethylated derivative of mechlorethamine, making this option close but technically incorrect. *Etoposide + Cisplatin* - **Etoposide** and **Cisplatin** are distinct chemotherapeutic agents often used in combination for various cancers, including **lung cancer** and **germ cell tumors**. - They do not form a single molecular conjugate like estramustine. *Tamoxifen + Letrozole* - **Tamoxifen** and **letrozole** are **endocrine therapies** used primarily in **breast cancer**. - Tamoxifen is a **selective estrogen receptor modulator (SERM)**, and letrozole is an **aromatase inhibitor**; they are not combined to form a single drug molecule like estramustine.

Q: Which of the following Human papillomavirus subtypes is not covered by the quadrivalent HPV vaccine, which protects against types 6, 11, 16, and 18?

Type 7. ***Type 7*** - The quadrivalent HPV vaccine, **Gardasil**, specifically targets HPV types **6, 11, 16, and 18**. - Therefore, **Type 7** is not covered by this particular vaccine, as it is not one of the designated strains. *Type 6* - **Type 6** is one of the target strains of the quadrivalent HPV vaccine. - This strain is commonly associated with the development of **genital warts**. *Type 11* - **Type 11** is another target strain of the quadrivalent HPV vaccine. - Like HPV Type 6, it is also a common cause of **genital warts** and **recurrent respiratory papillomatosis**. *Type 16* - **Type 16** is one of the high-risk HPV types targeted by the quadrivalent vaccine. - It is a primary cause of **cervical cancer** and other anogenital cancers. - Along with **Type 18**, these high-risk types account for approximately **70% of all cervical cancer cases worldwide**.

Q: Aspirin is used in chemoprevention of which cancer?

Colon cancer. ***Colon cancer*** - Aspirin has shown a role in **chemoprevention** for colorectal cancer, particularly in individuals with a high risk or a history of adenomas. - Its anti-inflammatory properties, specifically through **COX inhibition**, are thought to reduce tumor growth and metastasis in the colon. *Pancreatic cancer* - While some studies have explored aspirin's potential role, there is currently **insufficient evidence** to recommend it for the prevention or treatment of pancreatic cancer. - Pancreatic cancer is often diagnosed at advanced stages, and aspirin's benefits are primarily in **early prevention**. *Liver cancer* - Current research is **exploratory** regarding aspirin's role in liver cancer, primarily in **hepatocellular carcinoma (HCC)** patients. - Its use is not a standard recommendation for the management or prevention of liver cancer. *Stomach cancer* - There is **mixed and inconclusive evidence** regarding aspirin's direct benefit in stomach cancer prevention or treatment. - The primary concern with regular aspirin use in gastric conditions is the increased risk of **gastrointestinal bleeding** and ulcers.

Q: Which of the following statements about busulfan is false?

It can result in Addison's disease. ***It can result in Addison's disease*** - This statement is considered **false** in the context of traditional pharmacology teaching, though this requires clarification. - Busulfan causes **primary adrenocortical insufficiency** through direct cytotoxic damage to the adrenal cortex. - Traditionally, some sources reserve "Addison's disease" specifically for **autoimmune adrenalitis** (the most common cause), distinguishing it from other causes of primary adrenal insufficiency. - However, modern usage often considers **Addison's disease synonymous with primary adrenocortical insufficiency** of any etiology, including drug-induced. - For exam purposes, the distinction being tested is that busulfan causes **drug-induced adrenal toxicity**, not autoimmune destruction. *It can also cause veno occlusive disease of liver* - **TRUE** - Hepatic veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), is a well-documented complication of busulfan. - This is particularly common in **high-dose conditioning regimens** before hematopoietic stem cell transplantation. - Results from direct damage to hepatic **sinusoidal endothelial cells**. *It is an alkylating anti neoplastic drug* - **TRUE** - Busulfan is a **bifunctional alkylating agent** that cross-links DNA. - Belongs to the alkyl sulfonate class of alkylating agents. - Used primarily in **chronic myeloid leukemia (CML)** and as a conditioning agent before bone marrow transplantation. *It can lead to pulmonary fibrosis* - **TRUE** - "**Busulfan lung**" is a characteristic and serious long-term toxicity. - Can develop months to years after treatment. - Presents with progressive dyspnea and restrictive lung disease pattern.

Q: An example of an IMiD (immunomodulatory derivative of thalidomide) is:

Lenalidomide. ***Lenalidomide*** - **Lenalidomide** is a well-known **immunomodulatory imide drug (IMiD)** derived from thalidomide, commonly used in the treatment of multiple myeloma and myelodysplastic syndromes. - IMiDs are characterized by their ability to modulate immune responses, enhance T-cell and NK-cell activity, and have direct anti-cancer effects through inhibition of angiogenesis and tumor cell proliferation. *Palivizumab* - **Palivizumab** is a **monoclonal antibody** that targets the fusion protein of respiratory syncytial virus (RSV), used for prophylaxis in high-risk infants. - It is not classified as an immunomodulatory imide drug and has a completely different structure and mechanism of action. *Ribavirin* - **Ribavirin** is an **antiviral agent** primarily used to treat chronic hepatitis C virus infection and respiratory syncytial virus. - Its mechanism of action is antiviral, not immunomodulatory in the same way as IMiDs. *None of the options* - This option is incorrect because **Lenalidomide** is indeed an example of an IMiD, making the statement false. - At least one correct answer exists among the given choices.

Q: What is the mechanism of action of Bevacizumab?

Anti VEGF antibody. ***Anti VEGF antibody*** - **Bevacizumab** is a **monoclonal antibody** that specifically targets and binds to vascular endothelial growth factor (VEGF). - By inhibiting VEGF, bevacizumab prevents the formation of new blood vessels (**angiogenesis**) that tumors need to grow and metastasize. *Histone deacetylase inhibitor* - **Histone deacetylase (HDAC) inhibitors** influence gene expression by modifying chromatin structure, leading to cell cycle arrest and apoptosis in cancer cells. - They are used in certain hematologic malignancies and solid tumors but do not directly interfere with angiogenesis. *Proteasome inhibitor* - **Proteasome inhibitors** like bortezomib block the action of proteasomes, leading to an accumulation of ubiquitinated proteins and induction of apoptosis in cancer cells. - This mechanism is distinct from blocking new blood vessel formation. *HER2 neu inhibitor* - **HER2 neu inhibitors** (e.g., trastuzumab) specifically target the HER2/neu receptor, which is overexpressed in certain breast and gastric cancers. - Their action primarily involves blocking growth signals transmitted through this receptor, not inhibiting VEGF or angiogenesis.

Question 1

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

Accepted Answer

Breast

Answer

Endometrium

Answer

Ovary

Answer

All of the options

Question 2

Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

Accepted Answer

Cisplatin

Answer

Cyclophosphamide

Answer

Methotrexate

Answer

Dacarbazine

Question 3

The use of which of the following helps in reducing the toxicity of doxorubicin to the heart?

Accepted Answer

Dexrazoxane

Answer

Amifostine

Answer

Carboplatin

Answer

Flucytosine

Question 4

Anticancer drug causing syndrome of inappropriate antidiuretic hormone secretion (SIADH) as an adverse effect is:

Accepted Answer

Vincristine

Answer

Paclitaxel

Answer

Dacarbazine

Answer

Cyclophosphamide

Question 5

Estramustine is a combination of which two drugs?

Accepted Answer

Estradiol + Normustine

Answer

Estradiol + mechlorethamine

Answer

Etoposide + Cisplatin

Answer

Tamoxifen + Letrozole

Question 6

Which of the following Human papillomavirus subtypes is not covered by the quadrivalent HPV vaccine, which protects against types 6, 11, 16, and 18?

Accepted Answer

Type 7

Answer

Type 6

Answer

Type 11

Answer

Type 16

Question 7

Aspirin is used in chemoprevention of which cancer?

Accepted Answer

Colon cancer

Answer

Pancreatic cancer

Answer

Liver cancer

Answer

Stomach cancer

Question 8

Which of the following statements about busulfan is false?

Accepted Answer

It can result in Addison's disease

Answer

It can also cause veno occlusive disease of liver

Answer

It is an alkylating anti neoplastic drug

Answer

It can lead to pulmonary fibrosis

Question 9

An example of an IMiD (immunomodulatory derivative of thalidomide) is:

Accepted Answer

Lenalidomide

Answer

Palivizumab

Answer

Ribavirin

Answer

None of the options

Question 10

What is the mechanism of action of Bevacizumab?

Accepted Answer

Anti VEGF antibody

Answer

Histone deacetylase inhibitor

Answer

HER2 neu inhibitor

Answer

Proteasome inhibitor

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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