Anticancer Drugs Practice Questions

Q: What is the best single-drug chemotherapy agent for the treatment of carcinoma of the cheek?

Cisplatin. **Explanation:** **1. Why Cisplatin is the Correct Answer:** Carcinoma of the cheek (Squamous Cell Carcinoma of the Oral Cavity) is primarily managed surgically or with radiotherapy. However, when chemotherapy is indicated—either as a radiosensitizer or for palliative/recurrent cases—**Cisplatin** is considered the "gold standard" single-drug agent. It is a platinum-based alkylating-like agent that causes DNA cross-linking, leading to apoptosis. In Head and Neck Squamous Cell Carcinoma (HNSCC), Cisplatin demonstrates the highest response rates among single agents and is the backbone of most combination regimens (e.g., PF regimen: Cisplatin + 5-Fluorouracil). **2. Why the Other Options are Incorrect:** * **Cyclophosphamide (A):** An alkylating agent primarily used in lymphomas, breast cancer, and certain pediatric tumors. It has minimal efficacy in epithelial head and neck cancers. * **Vincristine (B):** A vinca alkaloid that inhibits microtubule formation. It is used in leukemias, lymphomas, and sarcomas (like rhabdomyosarcoma), but is not a primary agent for oral SCC. * **Daunorubicin (C):** An anthracycline used almost exclusively in acute leukemias (AML/ALL). It has no role in the management of solid tumors like cheek carcinoma. **3. NEET-PG High-Yield Pearls:** * **Drug of Choice:** Cisplatin is the most effective single agent for HNSCC. * **Radiosensitization:** Low-dose weekly Cisplatin is the standard concurrent chemotherapy given during radiotherapy to enhance local control. * **Side Effects:** Always remember the "C" triad for Cisplatin: **C**hemoreceptor trigger zone stimulation (highly emetogenic), **C**ochlear toxicity (ototoxicity), and **C**onvoluted tubule damage (nephrotoxicity). * **Amifostine** is used to reduce Cisplatin-induced nephrotoxicity.

Q: Which of the following statements about Tacrolimus is incorrect?

It can be safely administered with any nephrotoxic drug.. **Explanation:** **1. Why Option B is the Correct (Incorrect Statement):** Tacrolimus is a **calcineurin inhibitor** (CNI). Its most significant and dose-limiting toxicity is **nephrotoxicity**, which occurs due to potent vasoconstriction of the afferent arterioles. Administering Tacrolimus with other nephrotoxic drugs (such as Aminoglycosides, Amphotericin B, or NSAIDs) creates a synergistic toxic effect, significantly increasing the risk of acute kidney injury (AKI). Therefore, it cannot be "safely administered" with such drugs; close monitoring of serum creatinine and drug levels is mandatory. **2. Analysis of Other Options:** * **Option A:** Tacrolimus is chemically classified as a **macrolide**, though it lacks antibacterial activity. It is derived from the fungus *Streptomyces tsukubaensis*. * **Option C:** Tacrolimus is known to cause **post-transplant diabetes mellitus (PTDM)**. It impairs glucose tolerance by inhibiting insulin secretion from pancreatic beta cells more significantly than Cyclosporine. * **Option D:** It is a first-line immunosuppressant used for the **prophylaxis of organ rejection** in liver, kidney, and heart transplants. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Binds to **FKBP-12** (FK-binding protein) $\rightarrow$ inhibits Calcineurin $\rightarrow$ prevents dephosphorylation of **NFAT** $\rightarrow$ inhibits IL-2 transcription. * **Side Effect Profile (The "3 H's"):** **H**yperglycemia, **H**yperkalemia, and **H**ypertension. * **Neurotoxicity:** Tacrolimus is more neurotoxic than Cyclosporine (causing tremors, seizures, and headache). * **Comparison:** Unlike Cyclosporine, Tacrolimus does **not** cause hirsutism or gum hyperplasia; it may actually cause alopecia.

Q: Which adverse effect of Bleomycin is exacerbated by radiation exposure?

Pulmonary toxicity. ***Pulmonary toxicity*** - Bleomycin is well-known for causing dose-dependent **pulmonary fibrosis**. It damages **type I pneumocytes**, leading to inflammation, proliferation of **type II pneumocytes**, and eventual fibrosis, impairing gas exchange. - The risk of pulmonary toxicity is significantly increased by concurrent or prior **chest radiation therapy** and administration of high concentrations of supplemental **oxygen**, as both are also injurious to lung tissue. *Gastric toxicity* - Bleomycin is not typically associated with significant gastric toxicity. Common side effects are milder and include **mucositis** and **stomatitis** rather than severe gastric damage. - There is no evidence of a synergistic toxic effect on the gastric mucosa when Bleomycin is combined with radiation therapy. *Neural toxicity* - Neurotoxicity is not a characteristic side effect of Bleomycin. Chemotherapeutic agents like **vincristine** and **cisplatin** are more commonly associated with peripheral neuropathy. - While radiation can cause nerve damage, this is not a known interaction that is specifically exacerbated by Bleomycin administration. *Hepatotoxicity* - Severe liver damage (**hepatotoxicity**) is a rare side effect of Bleomycin. Mild and transient elevations of liver enzymes may occur but are not clinically significant. - Unlike the lungs, the liver is not a primary site for synergistic toxicity between Bleomycin and radiation therapy.

Q: Which of the following statements regarding Thalidomide is correct? a. It acts as an antimetabolite and is useful as an immunosuppressant b. It is used in the treatment of multiple myeloma c. It is used in the management of Type 2 lepra reaction (ENL) d. It is teratogenic

b, c, d. ***b, c, d*** - Statements b, c, and d are correct: Thalidomide is an **Immunomodulatory Drug (IMiD)** used effectively in the treatment of **multiple myeloma**, it is the drug of choice for **Erythema Nodosum Leprosum (ENL)** (Type 2 lepra reaction), and it is historically significant for causing **phocomelia** (teratogenicity). - Its mechanism involves downregulation of **pro-inflammatory cytokines** like TNF-alpha, which underlies its use in ENL, and anti-angiogenic/anti-proliferative effects against myeloma cells. *a, b, c* - Statement 'a' is incorrect because Thalidomide is an **Immunomodulatory Drug (IMiD)**, not an **antimetabolite** (a class of drugs that inhibit DNA/RNA synthesis). - Inclusion of the incorrect mechanism ('a') invalidates this set, despite 'b' (multiple myeloma) and 'c' (ENL) being correct clinical applications. *a, c, d* - This combination is incorrect primarily because it includes statement 'a', which wrongly defines Thalidomide as an **antimetabolite**. - Crucially, this option omits statement 'b', which is a major, current indication for Thalidomide in **multiple myeloma**. *a, b, d* - This combination wrongly includes the factual error of statement 'a' (it is not an **antimetabolite**). - It also misses statement 'c', which is the prominent use of Thalidomide in **Type 2 lepra reaction (ENL)**.

Q: Treatment with Herceptin in breast cancer is indicated for

Tumours with over-expressed HER2/C-erbB-2 protein. **tumours with over-expressed C-erb B-2 protein** - **Herceptin** (trastuzumab) is a monoclonal antibody that specifically targets the **HER2/neu receptor**, which is encoded by the *ERBB2* gene. - Its efficacy depends on the **overexpression of C-erbB-2 protein** (also known as HER2/neu) on the surface of breast cancer cells, which indicates **HER2-positive breast cancer**. *K : 67 stain +ve tumours* - **Ki-67** is a proliferation marker that indicates the **growth fraction of a tumor**, and a positive stain suggests a rapidly dividing tumor. - While Ki-67 positivity is associated with more aggressive tumors, it does **not directly indicate suitability for Herceptin** treatment. *PR receptor +ve tumours* - Tumors positive for the **progesterone receptor (PR)** are typically treated with **hormonal therapies**, such as tamoxifen or aromatase inhibitors. - **PR positivity** does not indicate responsiveness to Herceptin, which targets the HER2 receptor. *ER receptor +ve tumours* - Tumors positive for the **estrogen receptor (ER)** are also treated with **hormonal therapies** due to their dependence on estrogen for growth. - Similarly to PR-positive tumors, **ER positivity** does not determine eligibility for Herceptin therapy.

Q: Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:

Carcinoma breast. ***Carcinoma breast*** - **Herceptin (Trastuzumab)** is a monoclonal antibody that targets the **HER2 receptor**, which is overexpressed in a significant subset of breast cancers. - Its use is specifically indicated for **HER2-positive breast cancer**, where it helps to inhibit cancer cell growth and proliferation. *Carcinoma rectum* - Treatment for **colorectal cancer** (including rectal carcinoma) typically involves surgery, chemotherapy (e.g., 5-fluorouracil), and radiation, with targeted therapies like cetuximab or bevacizumab for specific mutations. - **HER2 overexpression** is rare in colorectal cancer and Trastuzumab is not a standard treatment. *Ovarian malignancy* - Treatment for **ovarian cancer** usually involves surgery and platinum-based chemotherapy (e.g., carboplatin, paclitaxel), and sometimes bevacizumab. - While HER2 can be expressed in some ovarian cancers, it is not a primary therapeutic target, and **Trastuzumab is not routinely used** for this malignancy. *Carcinoma prostate* - **Prostate cancer** treatment primarily involves hormone therapy, radiation, chemotherapy (e.g., docetaxel), and targeted agents for specific mutations (e.g., PARP inhibitors). - HER2 is not a significant driver of prostate cancer growth, and **Trastuzumab is not indicated** for its treatment.

Q: Match List-I with List-II and select the correct answer using the code given below the Lists: **List-I (Anticancer Drugs)** A. Cisplatinum B. Adriamycin C. Bleomycin D. Cyclophosphamide **List-II (Adverse Effects)** 1. Pulmonary fibrosis 2. Haemorrhagic cystitis 3. Tubular necrosis 4. Cardiomyopathy

A→3 B→4 C→1 D→2. ***A→3 B→4 C→1 D→2*** - This option correctly matches each anticancer drug to its characteristic adverse effect: **Cisplatinum (A)** with **tubular necrosis (3)**, **Adriamycin (B)** with **cardiomyopathy (4)**, **Bleomycin (C)** with **pulmonary fibrosis (1)**, and **Cyclophosphamide (D)** with **haemorrhagic cystitis (2)**. - These drug-toxicity associations are clinically important for monitoring and managing patients on chemotherapy. *A→3 B→4 C→2 D→1* - This option incorrectly matches Bleomycin with haemorrhagic cystitis (should be pulmonary fibrosis) and Cyclophosphamide with pulmonary fibrosis (should be haemorrhagic cystitis). - While Cisplatinum and Adriamycin are correctly paired, the last two associations are reversed. *A→4 B→3 C→2 D→1* - This option incorrectly matches Cisplatinum with cardiomyopathy (should be tubular necrosis) and Adriamycin with tubular necrosis (should be cardiomyopathy). - Additionally, Bleomycin and Cyclophosphamide complications are also incorrectly paired. *A→4 B→3 C→1 D→2* - This option incorrectly swaps the complications for Cisplatinum and Adriamycin: Cisplatinum is matched with cardiomyopathy (should be tubular necrosis) and Adriamycin with tubular necrosis (should be cardiomyopathy). - While Bleomycin and Cyclophosphamide are correctly paired with their respective complications, the first two associations are incorrect.

Q: All of the following are hormonal agents used in treatment of cancer EXCEPT:

Irinotecan. ***Irinotecan*** - **Irinotecan** is a **chemotherapeutic agent** that acts as a **topoisomerase I inhibitor**, interfering with DNA replication and repair. - It works through a **cytotoxic mechanism** directly killing cancer cells, rather than modulating hormonal pathways. *Cabergoline* - **Cabergoline** is a **dopamine agonist** primarily used to treat **prolactinomas**, which are prolactin-producing pituitary tumors. - While it treats a tumor, its mechanism is **hormonal modulation** by reducing prolactin secretion, not direct cytotoxicity. *Anastrozole* - **Anastrozole** is an **aromatase inhibitor** used in estrogen receptor-positive breast cancer. - It works by **blocking the conversion of androgens to estrogens**, thereby reducing estrogen levels that fuel cancer growth. *Leuprolide* - **Leuprolide** is a **GnRH agonist** used in prostate cancer, breast cancer, and other hormone-sensitive conditions. - It initially stimulates, then continuously downregulates, the **pituitary gland's production of LH and FSH**, leading to reduced testosterone or estrogen levels.

Question 1

What is the best single-drug chemotherapy agent for the treatment of carcinoma of the cheek?

Accepted Answer

Cisplatin

Answer

Cyclophosphamide

Answer

Vincristine

Answer

Danorubicin

Question 2

Which of the following statements about Tacrolimus is incorrect?

Accepted Answer

It can be safely administered with any nephrotoxic drug.

Answer

It is a macrolide antibiotic.

Answer

Glucose intolerance is a well-known side effect.

Answer

It is used for prophylaxis of transplant rejection.

Question 3

What is the key difference between Cisplatin and Carboplatin?

Accepted Answer

Cisplatin has more nephrotoxic side effects compared to Carboplatin

Answer

Cisplatin is less neurotoxic than Carboplatin

Answer

Carboplatin is more neurotoxic than Cisplatin

Answer

Cisplatin causes fewer gastric issues compared to Carboplatin

Question 4

Which adverse effect of Bleomycin is exacerbated by radiation exposure?

Accepted Answer

Pulmonary toxicity

Answer

Neural toxicity

Answer

Hepatotoxicity

Answer

Gastric toxicity

Question 5

What is the primary mechanism of action of methotrexate?

Accepted Answer

Inhibits dihydrofolate reductase, leading to decreased DNA synthesis

Answer

Inhibits RNA synthesis by blocking RNA polymerase

Answer

Interferes with microtubule formation during cell division

Answer

Inhibits DNA synthesis by blocking thymidylate synthase

Question 6

Which of the following statements regarding Thalidomide is correct?
a. It acts as an antimetabolite and is useful as an immunosuppressant
b. It is used in the treatment of multiple myeloma
c. It is used in the management of Type 2 lepra reaction (ENL)
d. It is teratogenic

Accepted Answer

b, c, d

Answer

a, b, d

Answer

a, b, c

Answer

a, c, d

Question 7

Treatment with Herceptin in breast cancer is indicated for

Accepted Answer

Tumours with over-expressed HER2/C-erbB-2 protein

Answer

PR receptor +ve tumours

Answer

ER receptor +ve tumours

Answer

Ki-67 stain +ve tumours

Question 8

Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:

Accepted Answer

Carcinoma breast

Answer

Carcinoma rectum

Answer

Ovarian malignancy

Answer

Carcinoma prostate

Question 9

Match List-I with List-II and select the correct answer using the code given below the Lists:

**List-I (Anticancer Drugs)**
A. Cisplatinum
B. Adriamycin
C. Bleomycin
D. Cyclophosphamide

**List-II (Adverse Effects)**
1. Pulmonary fibrosis
2. Haemorrhagic cystitis
3. Tubular necrosis
4. Cardiomyopathy

Accepted Answer

A→3  B→4  C→1  D→2

Answer

A→3  B→4  C→2  D→1

Answer

A→4  B→3  C→2  D→1

Answer

A→4  B→3  C→1  D→2

Question 10

All of the following are hormonal agents used in treatment of cancer EXCEPT:

Accepted Answer

Irinotecan

Answer

Cabergoline

Answer

Leuprolide

Answer

Anastrozole

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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