Anticancer Drugs Practice Questions

Q: Which monoclonal antibody targets CD20 and is used in treating Non-Hodgkin Lymphoma (NHL)?

Rituximab. **Explanation:** **Rituximab** is the correct answer. It is a chimeric monoclonal antibody that specifically targets the **CD20 antigen**, which is expressed on the surface of normal and malignant B-lymphocytes. By binding to CD20, Rituximab induces B-cell lysis through antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and apoptosis. It is a cornerstone therapy for **B-cell Non-Hodgkin Lymphomas (NHL)**, such as Diffuse Large B-cell Lymphoma (DLBCL) and Follicular Lymphoma, as well as Chronic Lymphocytic Leukemia (CLL). **Analysis of Incorrect Options:** * **A. Cyclophosphamide:** This is an **alkylating agent** (nitrogen mustard), not a monoclonal antibody. It works by cross-linking DNA. While used in NHL (as part of the CHOP regimen), it does not target CD20. * **B. Trastuzumab:** This monoclonal antibody targets the **HER2/neu (ErbB2) receptor**. It is primarily used in the treatment of HER2-positive breast cancer and gastric cancer. * **C. Denosumab:** This is a monoclonal antibody against **RANKL** (Receptor Activator of Nuclear Factor kappa-B Ligand). It is used to treat osteoporosis and giant cell tumor of bone by inhibiting osteoclast activity. **High-Yield Clinical Pearls for NEET-PG:** * **Infusion Reaction:** The most common side effect of Rituximab is an infusion-related reaction (fever, chills, rash); premedication with paracetamol and antihistamines is standard. * **HBV Reactivation:** Always screen for Hepatitis B before starting Rituximab, as it can cause fatal viral reactivation. * **PML:** Rituximab is associated with a rare risk of Progressive Multifocal Leukoencephalopathy (PML) due to JC virus reactivation. * **Other CD20 Inhibitors:** Newer agents include **Ofatumumab** and **Obinutuzumab**.

Q: Which of the following adverse effects may be caused by Busulfan?

Pulmonary fibrosis. **Explanation:** **Busulfan** is an alkylating agent (specifically an alkyl sulfonate) used primarily in the treatment of Chronic Myeloid Leukemia (CML) and as a conditioning agent before bone marrow transplantation. **Why Pulmonary Fibrosis is correct:** Busulfan is notorious for causing dose-dependent interstitial pulmonary fibrosis, often referred to as **"Busulfan Lung."** This occurs due to the drug’s ability to cause oxidative stress and damage to alveolar epithelial cells, leading to fibroblast proliferation. Patients typically present with dyspnea and cough months to years after starting therapy. **Analysis of Incorrect Options:** * **A. Cystitis:** Hemorrhagic cystitis is a classic side effect of **Cyclophosphamide** and **Ifosfamide** due to the metabolite **Acrolein**. It is managed with Mesna and aggressive hydration. * **C. Loss of hair (Alopecia):** While many cytotoxic drugs cause alopecia, Busulfan is unique because it causes minimal to no hair loss at standard doses, making this an unlikely primary answer compared to the specific lung toxicity. * **D. Peripheral neuropathy:** This is the dose-limiting toxicity of **Vinca alkaloids** (Vincristine) and **Taxanes** (Paclitaxel), caused by interference with microtubule function. **High-Yield Clinical Pearls for NEET-PG:** * **Adrenal-like insufficiency:** Busulfan can cause a syndrome characterized by hyperpigmentation, wasting, and hypotension (Addisonian-like syndrome), but without actual biochemical adrenal failure. * **Mnemonic:** "B" for **B**usulfan, **B**one marrow suppression (prolonged), and **B**ig lung (fibrosis). * **Seizures:** At high doses (pre-transplant), Busulfan can cross the blood-brain barrier and cause seizures; prophylactic anticonvulsants (like Phenytoin) are often used.

Q: A 42-year-old woman has been diagnosed with liver cancer and is being treated with 5-FU. 5-FU is successful in destroying the tumor cells because it blocks the production of which one of the following?

dTMP. Explanation:Mechanism of Action (Why dTMP is correct):5-Fluorouracil (5-FU) is a pyrimidine analog and a cycle-specific antimetabolite. Inside the cell, it is converted into its active metabolite, **5-FdUMP** (5-fluorodeoxyuridine monophosphate) [1, 2]. This metabolite acts as a suicide inhibitor of the enzyme **Thymidylate Synthase** [1, 2]. Normally, this enzyme converts dUMP to **dTMP** (deoxythymidine monophosphate) by adding a methyl group [2]. By inhibiting this step, 5-FU causes a "thymineless death" of the cell, as dTMP is essential for DNA synthesis and repair [1].Analysis of Incorrect Options:* **A. FH4 (Tetrahydrofolate):** 5-FU does not block the production of FH4. However, it requires N5,N10-methylene FH4 as a co-factor to form a stable ternary complex with Thymidylate Synthase [1].* **C. UMP (Uridine Monophosphate):** 5-FU is a fluorinated analog of uracil; it mimics the precursors but does not block the initial synthesis of UMP itself.* **D. Methylcobalamin:** This is a form of Vitamin B12 involved in the conversion of homocysteine to methionine. 5-FU has no direct inhibitory effect on B12 metabolism.NEET-PG High-Yield Pearls:* **Leucovorin Rescue vs. Potentiation:** Unlike in Methotrexate toxicity (where Leucovorin is used as a "rescue"), Leucovorin is given with 5-FU to **potentiate** its action by stabilizing the binding of 5-FdUMP to Thymidylate Synthase.* **Adverse Effects:** Hand-foot syndrome (palmar-plantar erythrodysesthesia) and GI toxicity (mucositis) are characteristic.* **Dihydropyrimidine Dehydrogenase (DPD) Deficiency:** Patients with this genetic deficiency are at high risk of severe, life-threatening toxicity when given 5-FU.

Q: All of the following are used to limit the toxicity of cisplatin except:

N-acetylcysteine. The primary dose-limiting toxicity of **Cisplatin** is **nephrotoxicity** (acute tubular necrosis). This occurs because cisplatin accumulates in the renal proximal tubules, leading to oxidative stress and DNA damage [1]. **1. Why N-acetylcysteine (NAC) is the correct answer:** While NAC is a potent antioxidant and the specific antidote for **Acetaminophen (Paracetamol) toxicity**, it is **not** a standard clinical intervention used to prevent cisplatin-induced nephrotoxicity. Its role in this context remains experimental and is not part of established oncology protocols. **2. Why the other options are incorrect (Standard Preventive Measures):** * **Chloride Diuresis:** This is the most critical preventive step. Administering Cisplatin in **Normal Saline (0.9% NaCl)** maintains a high chloride concentration in the renal tubules [1]. High chloride levels suppress the conversion of cisplatin into its highly reactive (and toxic) aquated form, thereby protecting the kidneys. * **Slow Rate of Infusion:** Rapid bolus doses increase peak plasma concentrations, significantly raising the risk of renal damage. Infusing the drug slowly over several hours reduces the peak concentration reaching the kidneys. * **Amifostine:** This is a cytoprotective adjuvant (a prodrug) that is converted by alkaline phosphatase into a free thiol. It acts as a scavenger for reactive metabolites of cisplatin specifically in normal tissues, reducing nephrotoxicity without compromising antitumor efficacy [1]. **Clinical Pearls for NEET-PG:** * **Cisplatin Triad of Toxicity:** Nephrotoxicity, Ototoxicity (high-frequency hearing loss), and severe Emetogenicity (requires 5-HT3 antagonists + Dexamethasone + Aprepitant) [1]. * **Carboplatin:** A cisplatin analogue with less nephrotoxicity but significant **myelosuppression** (thrombocytopenia). * **Amifostine** is also used to reduce xerostomia (dry mouth) in patients undergoing radiotherapy.

Q: For which of the following cancers can retinoids be used for treatment?

Cutaneous T-cell lymphoma. **Explanation:** Retinoids are natural and synthetic derivatives of Vitamin A that regulate cell growth, differentiation, and apoptosis by binding to specific nuclear receptors (RAR and RXR). **Why Cutaneous T-cell lymphoma (CTCL) is correct:** **Bexarotene**, a third-generation selective retinoid X receptor (RXR) agonist, is specifically FDA-approved for the treatment of refractory Cutaneous T-cell lymphoma (including Mycosis Fungoides). It induces apoptosis and inhibits the cell cycle progression of malignant T-cells. Additionally, **All-trans retinoic acid (ATRA)** is a cornerstone in treating Acute Promyelocytic Leukemia (APML) by inducing the differentiation of leukemic promyelocytes. **Why other options are incorrect:** * **Bladder, Stomach, and Liver Cancers:** While retinoids have been studied for their potential "chemopreventive" properties in various epithelial malignancies, they are not standard-of-care therapeutic agents for these solid tumors. These cancers are primarily managed with surgery, radiation, and conventional cytotoxic chemotherapy (e.g., Gemcitabine/Cisplatin for bladder, Fluorouracil for stomach). **High-Yield Clinical Pearls for NEET-PG:** * **APML (M3):** ATRA is the drug of choice. Watch for **"Differentiation Syndrome"** (fever, respiratory distress), treated with Dexamethasone. * **Acne & Psoriasis:** Isotretinoin (oral) and Tazarotene (topical) are common dermatological uses. * **Adverse Effects:** Hypertriglyceridemia, dry skin/mucosa, and **teratogenicity** (mandatory pregnancy testing is required before prescription). * **Alitretinoin:** Used topically for Kaposi Sarcoma lesions.

Q: The combination of meclorethamine, vincristine, prednisolone, and procarbazine is used for the treatment of patients with which condition?

Hodgkin's disease. **Explanation:** The combination of **Meclorethamine, Oncovin (Vincristine), Procarbazine, and Prednisolone** is known as the **MOPP regimen**. This was the first chemotherapy combination to achieve a high cure rate in advanced **Hodgkin’s disease (HD)**. * **Mechanism:** Each drug in this regimen targets the cell cycle differently to maximize cytotoxicity while minimizing overlapping toxicities. Meclorethamine is an alkylating agent (nitrogen mustard), Vincristine is a microtubule inhibitor, Procarbazine is a unique alkylating agent that also inhibits DNA/RNA synthesis, and Prednisolone provides lympholytic effects. * **Clinical Note:** While MOPP was the gold standard, it has largely been replaced by the **ABVD regimen** (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine) because ABVD is less leukemogenic and does not cause the permanent sterility associated with the MOPP regimen. **Analysis of Incorrect Options:** * **A. Acute Lymphocytic Leukemia (ALL):** The standard induction regimen typically involves Vincristine, Prednisolone, L-Asparaginase, and an Anthracycline (e.g., Daunorubicin). * **B. Chronic Lymphocytic Leukemia (CLL):** Treatment usually involves targeted therapies like Ibrutinib or Fludarabine-based regimens (FCR: Fludarabine, Cyclophosphamide, Rituximab). * **D. Acute Myelocytic Leukemia (AML):** The classic treatment is the **"7+3" regimen**, consisting of Cytarabine (7 days) and an Anthracycline like Daunorubicin (3 days). **High-Yield Clinical Pearls for NEET-PG:** * **MOPP side effect:** High risk of **secondary leukemia** (AML) and **sterility** (azoospermia). * **ABVD side effect:** Pulmonary fibrosis (Bleomycin) and Cardiotoxicity (Adriamycin/Doxorubicin). * **Procarbazine:** Known for causing a **Disulfiram-like reaction** with alcohol and hypertensive crises with tyramine-rich foods (MAO inhibition).

Q: Which of the following antineoplastic drugs should not be administered to a chronic alcoholic patient due to the risk of developing a disulfiram-like reaction?

Procarbazine. **Explanation:** **Procarbazine** is the correct answer because it is a methylhydrazine derivative that possesses unique biochemical properties, including the inhibition of several enzymes. Most notably, it inhibits **aldehyde dehydrogenase (ALDH)**, the enzyme responsible for metabolizing acetaldehyde into acetic acid. When a patient taking procarbazine consumes alcohol, acetaldehyde accumulates in the blood, leading to a **disulfiram-like reaction** characterized by flushing, tachycardia, nausea, vomiting, and hypotension. **Analysis of Options:** * **Procarbazine (Correct):** In addition to ALDH inhibition, it is a weak **Monoamine Oxidase (MAO) inhibitor**. Patients must avoid tyramine-rich foods (cheese, wine) to prevent hypertensive crises. It is primarily used in the MOPP regimen for Hodgkin’s Lymphoma. * **Dacarbazine:** An alkylating agent used in melanoma and Hodgkin’s (ABVD regimen). Its main side effect is severe emesis, but it does not cause disulfiram-like reactions. * **Melphalan:** A nitrogen mustard alkylating agent used primarily in Multiple Myeloma. Its toxicity is mainly hematological (bone marrow suppression). * **Hydroxyurea:** An S-phase specific inhibitor of ribonucleotide reductase used in CML and Sickle Cell Anemia. It does not interfere with alcohol metabolism. **High-Yield Clinical Pearls for NEET-PG:** * **Other drugs causing Disulfiram-like reactions:** Metronidazole (most common), Tinidazole, Cefotetan, Cefoperazone, Chlorpropamide, and Griseofulvin. * **Procarbazine Toxicity:** It is highly leukemogenic and carries a high risk of causing secondary acute leukemia. * **Mnemonic:** Remember **"P"** for Procarbazine, **"P"** for Pro-drug, and **"P"** for Psychosis (as it can cross the BBB and cause CNS effects).

Q: What is the drug of choice for surgically unresectable renal cell carcinoma?

Sunitinib. **Explanation:** **Sunitinib** is the drug of choice for surgically unresectable or metastatic **Renal Cell Carcinoma (RCC)**. The underlying medical concept involves the pathophysiology of RCC, which is a highly vascular tumor often associated with the loss of the VHL (von Hippel-Lindau) gene. This loss leads to an overproduction of **Vascular Endothelial Growth Factor (VEGF)**. Sunitinib is an oral multi-kinase inhibitor that targets VEGF receptors (VEGFR-1, 2, and 3) and Platelet-Derived Growth Factor receptors (PDGFR), effectively inhibiting angiogenesis and tumor cell proliferation. **Analysis of Incorrect Options:** * **Sorafenib (Option A):** While also a multi-kinase inhibitor used in RCC, it is generally considered a second-line agent or used when sunitinib is not tolerated. It is the drug of choice for **Hepatocellular Carcinoma (HCC)**. * **Imatinib (Option B):** This is a selective BCR-ABL tyrosine kinase inhibitor. It is the drug of choice for **Chronic Myeloid Leukemia (CML)** and Gastrointestinal Stromal Tumors (GIST). * **Cetuximab (Option D):** This is a monoclonal antibody against the **Epidermal Growth Factor Receptor (EGFR)**. It is primarily used in the treatment of metastatic colorectal cancer and head and neck squamous cell carcinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Pazopanib** is an alternative first-line agent for RCC with a similar mechanism to Sunitinib but a different side-effect profile. * **Side Effect Highlight:** Sunitinib is notorious for causing **Hand-Foot Syndrome** (palmar-plantar erythrodysesthesia) and potential cardiotoxicity (decreased LVEF). * **Temsirolimus/Everolimus:** These are mTOR inhibitors used specifically in high-risk/poor-prognosis RCC.

Question 1

Which monoclonal antibody targets CD20 and is used in treating Non-Hodgkin Lymphoma (NHL)?

Accepted Answer

Rituximab

Answer

Cyclophosphamide

Answer

Trastuzumab

Answer

Denosumab

Question 2

Which of the following adverse effects may be caused by Busulfan?

Accepted Answer

Pulmonary fibrosis

Answer

Cystitis

Answer

Loss of hair

Answer

Peripheral neuropathy

Question 3

A 42-year-old woman has been diagnosed with liver cancer and is being treated with 5-FU. 5-FU is successful in destroying the tumor cells because it blocks the production of which one of the following?

Accepted Answer

dTMP

Answer

FH4

Answer

UMP

Answer

Methylcobalamin

Question 4

All of the following are used to limit the toxicity of cisplatin except:

Accepted Answer

N-acetylcysteine

Answer

Slow rate of infusion

Answer

Chloride diuresis

Answer

Amifostine

Question 5

For which of the following cancers can retinoids be used for treatment?

Accepted Answer

Cutaneous T-cell lymphoma

Answer

Bladder

Answer

Stomach

Answer

Liver

Question 6

Methotrexate resistance is due to?

Accepted Answer

Increased concentrations of intracellular dihydrofolate reductase (DHFR) through gene amplification

Answer

Failure of efflux pumps

Answer

Bacterial modification

Answer

Increased synthesis of polyglutamates

Question 7

Bevacizumab is used in which of the following carcinomas?

Accepted Answer

Renal carcinoma

Answer

Breast carcinoma

Answer

Hepatic carcinoma

Answer

Lung carcinoma

Question 8

The combination of meclorethamine, vincristine, prednisolone, and procarbazine is used for the treatment of patients with which condition?

Accepted Answer

Hodgkin's disease

Answer

Acute lymphocytic leukemia

Answer

Chronic lymphocytic leukemia

Answer

Acute myelocytic leukemia

Question 9

Which of the following antineoplastic drugs should not be administered to a chronic alcoholic patient due to the risk of developing a disulfiram-like reaction?

Accepted Answer

Procarbazine

Answer

Dacarbazine

Answer

Melphalan

Answer

Hydroxyurea

Question 10

What is the drug of choice for surgically unresectable renal cell carcinoma?

Accepted Answer

Sunitinib

Answer

Sorafenib

Answer

Imatinib

Answer

Cetuximab

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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