Anti-neoplastic drugs — MCQs

A 70-year-old man with metastatic castration-resistant prostate cancer has rising PSA despite enzalutamide therapy. Imaging shows new bone metastases but no visceral disease. He has a history of well-controlled seizures on levetiracetam, type 2 diabetes on metformin, and stage 3 chronic kidney disease (eGFR 42 mL/min). Genetic testing shows BRCA2 germline mutation and homologous recombination deficiency. The oncologist considers four treatment options: docetaxel chemotherapy, radium-223, olaparib, or lutetium-177-PSMA. Synthesize the clinical data and evaluate the optimal treatment considering efficacy, mechanism, and patient-specific factors.

A 38-year-old woman with metastatic colon cancer has progressed through multiple lines of therapy including FOLFOX, FOLFIRI, and bevacizumab. Molecular testing reveals microsatellite instability-high (MSI-H) status and BRAF V600E mutation. She has excellent performance status but developed severe neuropathy from prior oxaliplatin. Her oncologist is considering three options: regorafenib, pembrolizumab, or encorafenib plus cetuximab. Evaluate the tumor biology and synthesize the optimal treatment strategy considering efficacy and toxicity.

A 52-year-old woman with newly diagnosed acute promyelocytic leukemia (APL) presents with WBC count of 45 × 10^9/L, pancytopenia, and coagulopathy (PT 18 sec, PTT 42 sec, fibrinogen 95 mg/dL, D-dimer elevated). She is started on all-trans retinoic acid (ATRA) and arsenic trioxide. On day 7, she develops fever, dyspnea, hypotension, pulmonary infiltrates on chest X-ray, and weight gain of 5 kg. Her WBC is now 78 × 10^9/L. Evaluate the pathophysiology and synthesize the optimal management strategy.

A 67-year-old man with chronic lymphocytic leukemia is being considered for treatment with ibrutinib. His medications include warfarin for atrial fibrillation (INR therapeutic at 2.5), lisinopril, and metformin. He has normal renal and hepatic function. His CHA2DS2-VASc score is 4. Analyze the drug interactions and evaluate the safest anticoagulation strategy.

A 42-year-old man with metastatic melanoma is started on ipilimumab and nivolumab combination immunotherapy. After the second dose, he develops severe watery diarrhea (8-10 stools/day), abdominal cramping, and rectal bleeding. Colonoscopy shows diffuse colitis with ulcerations. Laboratory tests show normal electrolytes and kidney function. Stool studies for infectious causes are negative. Analyze the underlying mechanism and determine appropriate management.

A 58-year-old woman with metastatic HER2-positive breast cancer has been on trastuzumab and pertuzumab for 18 months with good disease control. She now presents with progressive dyspnea on exertion. Echocardiography shows left ventricular ejection fraction of 42% (baseline 65%). She has no history of cardiac disease and previous anthracycline exposure was 4 years ago. Analyze the pathophysiology and determine the management approach.

A 48-year-old man receiving cisplatin-based chemotherapy for testicular cancer develops tinnitus and difficulty hearing conversations. Audiometry confirms bilateral high-frequency sensorineural hearing loss. He has completed 2 of 4 planned cycles. His tumor markers are decreasing appropriately. Apply the most appropriate modification to his treatment regimen.

A 55-year-old woman with acute myeloid leukemia is being treated with cytarabine and idarubicin. On day 5 of therapy, laboratory results show: WBC 0.8 × 10^9/L, hemoglobin 7.2 g/dL, platelets 18 × 10^9/L, potassium 6.8 mEq/L, phosphate 6.2 mg/dL, uric acid 12.5 mg/dL, creatinine 2.8 mg/dL (baseline 0.9). Apply the immediate management for this patient's condition.

A 62-year-old man with metastatic colorectal cancer is started on FOLFOX chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin). After the first cycle, he develops numbness and tingling in his fingers that worsens when he drinks cold beverages. Apply the appropriate management strategy for this patient's symptoms.

A 45-year-old woman with metastatic breast cancer presents with severe nausea and vomiting 24 hours after receiving her first cycle of doxorubicin and cyclophosphamide chemotherapy. She has tried ondansetron without relief. Her ECG shows QTc of 380 ms, and she has no history of cardiac disease. Apply the appropriate antiemetic management for this patient.