Anticancer Drugs — MCQs
On this page
Which of the following drugs causes hemorrhagic cystitis?
Which of the following drugs is known to cause hemorrhagic cystitis as a side effect?
Which of the following is a VEGF inhibitor?
Which is a glycoprotein, produced by many mammalian cells, and used in the treatment of hepatitis, papillomaviruses, hairy-cell leukemia, and AIDS-related Kaposi's sarcoma?
Which of the following is a cytoprotectant?
Anticancer Drugs Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following drugs causes hemorrhagic cystitis?
- A. Cyclophosphamide (Correct Answer)
- B. Cycloserine
- C. Ciprofloxacin
- D. Cyclosporine
Explanation: **Explanation:** **Cyclophosphamide** is a nitrogen mustard alkylating agent. Its metabolism in the liver produces a toxic metabolite called **Acrolein**. Acrolein is excreted in the urine, where it causes direct irritation and sloughing of the bladder mucosa, leading to **hemorrhagic cystitis**. This condition is characterized by gross hematuria and bladder pain. **Analysis of Options:** * **Cycloserine (B):** An antitubercular drug (second-line) primarily known for its neurotoxic side effects, such as seizures and psychosis. * **Ciprofloxacin (C):** A fluoroquinolone antibiotic. Common side effects include tendon rupture and QT prolongation, but not bladder toxicity. * **Cyclosporine (D):** An immunosuppressant (calcineurin inhibitor). Its dose-limiting toxicity is **nephrotoxicity** (afferent arteriolar vasoconstriction), not cystitis. **High-Yield Clinical Pearls for NEET-PG:** * **Prevention:** Hemorrhagic cystitis can be prevented by aggressive hydration and the administration of **MESNA** (2-Mercaptoethane Sulfonate Na). MESNA contains a thiol group that binds to and neutralizes acrolein in the bladder. * **Other Drug:** **Ifosfamide** is another alkylating agent that produces acrolein and carries an even higher risk of hemorrhagic cystitis than cyclophosphamide. * **Long-term Risk:** Chronic irritation from cyclophosphamide can increase the risk of **transitional cell carcinoma** of the bladder. * **Other Side Effects:** Cyclophosphamide is also associated with SIADH and infertility (premature ovarian failure/azoospermia).
Question 2: Which of the following drugs is known to cause hemorrhagic cystitis as a side effect?
- A. 5-Fluorouracil
- B. Methotrexate
- C. Bleomycin
- D. Cyclophosphamide (Correct Answer)
Explanation: **Explanation:** **Cyclophosphamide** is an alkylating agent (nitrogen mustard) that is metabolized in the liver to form two active metabolites: phosphoramide mustard (the therapeutic moiety) and **acrolein**. Acrolein is a toxic byproduct that accumulates in the urinary bladder, causing direct irritation and sloughing of the bladder mucosa, leading to **hemorrhagic cystitis**. **Why the other options are incorrect:** * **A. 5-Fluorouracil (5-FU):** An antimetabolite (pyrimidine analog) primarily known for causing gastrointestinal toxicity (mucositis, diarrhea) and **Hand-Foot Syndrome** (palmar-plantar erythrodysesthesia). * **B. Methotrexate:** A folate antagonist known for bone marrow suppression, hepatotoxicity, and **nephrotoxicity** (due to crystalluria), but not hemorrhagic cystitis. * **C. Bleomycin:** A cytotoxic antibiotic famous for causing **pulmonary fibrosis** and skin hyperpigmentation. It is "bone marrow sparing." **High-Yield Clinical Pearls for NEET-PG:** 1. **Prevention:** Hemorrhagic cystitis can be prevented by aggressive hydration and the administration of **MESNA** (2-Mercaptoethane Sulfonate Na). 2. **Mechanism of MESNA:** It contains a thiol (-SH) group that binds to and neutralizes acrolein in the bladder to form a non-toxic compound. 3. **Other Drugs:** **Ifosfamide** (an analog of cyclophosphamide) is even more likely to cause hemorrhagic cystitis and always requires MESNA prophylaxis. 4. **Long-term Risk:** Chronic irritation from acrolein increases the risk of **transitional cell carcinoma** of the bladder.
Question 3: Which of the following is a VEGF inhibitor?
- A. Bevacizumab (Correct Answer)
- B. Omalizumab
- C. Adalizumab
- D. Abciximab
Explanation: **Explanation:** **1. Correct Answer: A. Bevacizumab** Bevacizumab is a recombinant humanized monoclonal antibody that acts as a **VEGF (Vascular Endothelial Growth Factor) inhibitor**. It binds directly to circulating VEGF-A, preventing it from interacting with its receptors (VEGFR-1 and VEGFR-2) on the surface of endothelial cells. This inhibits **angiogenesis** (the formation of new blood vessels), thereby "starving" the tumor of the blood supply required for growth and metastasis. It is clinically used in colorectal cancer, renal cell carcinoma, and age-related macular degeneration (AMD). **2. Analysis of Incorrect Options:** * **B. Omalizumab:** This is a monoclonal antibody against **IgE**. It is used in the management of moderate-to-severe persistent allergic asthma and chronic urticaria. * **C. Adalizumab:** This is a **TNF-α (Tumor Necrosis Factor) inhibitor**. It is used in chronic inflammatory conditions such as Rheumatoid Arthritis, Psoriasis, and Crohn’s disease. * **D. Abciximab:** This is a **Glycoprotein IIb/IIIa receptor antagonist**. It inhibits platelet aggregation and is used during percutaneous coronary intervention (PCI) to prevent ischemic complications. **3. NEET-PG High-Yield Pearls:** * **Side Effects of Bevacizumab:** The most characteristic side effect is **Hypertension**. Other risks include GI perforation, impaired wound healing (should be stopped before surgery), and proteinuria. * **Nomenclature Tip:** Monoclonal antibodies ending in **"-umab"** are human; **"-ximab"** are chimeric; **"-zumab"** are humanized. * **Other VEGF Inhibitors:** **Ranibizumab** and **Pegaptanib** (used intravitreally for wet AMD) and **Ziv-aflibercept** (a "VEGF trap").
Question 4: Which is a glycoprotein, produced by many mammalian cells, and used in the treatment of hepatitis, papillomaviruses, hairy-cell leukemia, and AIDS-related Kaposi's sarcoma?
- A. Interferon (Correct Answer)
- B. Idoxuridine
- C. Zidovudine
- D. Zalcitabine
Explanation: **Explanation:** **Correct Answer: A. Interferon** Interferons (IFNs) are endogenous **glycoproteins** produced by host cells in response to viral infections, tumors, and other biological inducers. They act by binding to specific cell surface receptors, triggering the synthesis of enzymes (like 2’,5’-oligoadenylate synthetase) that inhibit viral protein synthesis and degrade viral RNA. * **Clinical Utility:** Interferon-alpha (IFN-α) is the specific subtype used for the conditions mentioned. It has potent antiviral and antiproliferative properties, making it the drug of choice for **Hairy-cell leukemia**, **Kaposi’s sarcoma** (in AIDS patients), **Chronic Hepatitis B and C**, and **Condyloma acuminatum** (caused by Papillomaviruses). **Why other options are incorrect:** * **B. Idoxuridine:** A pyrimidine analogue used primarily as a topical antiviral for Herpes Simplex Keratitis. It is not a glycoprotein and is too toxic for systemic use. * **C. Zidovudine (AZT):** A nucleoside reverse transcriptase inhibitor (NRTI). While used in AIDS, it is a synthetic drug, not a glycoprotein, and is not used for Hairy-cell leukemia or Hepatitis. * **D. Zalcitabine:** Another NRTI used in HIV treatment. Like Zidovudine, it lacks the broad-spectrum anticancer and glycoprotein properties of Interferons. **NEET-PG High-Yield Pearls:** * **Interferon-alpha:** Used in Hairy-cell leukemia, Kaposi’s sarcoma, and Hepatitis B/C. * **Interferon-beta:** Used primarily in **Multiple Sclerosis** to reduce the frequency of relapses. * **Interferon-gamma:** Used in **Chronic Granulomatous Disease** to reduce infections. * **Side Effects:** The most common side effect is a **"Flu-like syndrome"** (fever, chills, myalgia) and dose-limiting bone marrow suppression.
Question 5: Which of the following is a cytoprotectant?
- A. Minocycline
- B. Oxytetracycline
- C. Amifostine (Correct Answer)
- D. Doxycycline
Explanation: **Explanation:**Amifostine is the correct answer because it is a pharmacological cytoprotectant specifically designed to reduce the toxic effects of chemotherapy and radiotherapy. It is a prodrug that is converted by alkaline phosphatase in tissues to an active free thiol metabolite. This metabolite acts as a scavenger for free radicals generated by cisplatin or radiation, thereby protecting normal tissues without compromising the anti-tumor efficacy of the treatment. * **Clinical Use:** It is primarily used to reduce cumulative renal toxicity from **cisplatin** in patients with advanced ovarian cancer and to reduce the incidence of **xerostomia** (dry mouth) in patients undergoing radiotherapy for head and neck cancer. **Why the other options are incorrect:** * **Minocycline, Oxytetracycline, and Doxycycline (Options A, B, D):** These are all members of the **Tetracycline** class of broad-spectrum antibiotics. They work by inhibiting protein synthesis (binding to the 30S ribosomal subunit) and have no role as cytoprotectants in oncology [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Mesna:** Another vital cytoprotectant used to prevent hemorrhagic cystitis caused by **Cyclophosphamide** and **Ifosfamide** [1]. * **Dexrazoxane:** An iron-chelating cytoprotectant used to prevent anthracycline-induced (e.g., **Doxorubicin**) cardiotoxicity. * **Leucovorin (Folinic Acid):** Used as a
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
Practice Questions
Immunotherapy
Practice Questions
Management of Chemotherapy Side Effects
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free