Anticancer Drugs Practice Questions

Q: Which of the following is not a commonly reported adverse effect of imatinib?

Hepatotoxicity. ***Hepatotoxicity*** - **Hepatotoxicity IS a commonly reported adverse effect** of imatinib, occurring in approximately **10-15% of patients** with elevated liver enzymes. - However, compared to the **extremely high frequency** of fluid retention manifestations (occurring in 50-70% of patients), hepatotoxicity is **relatively less characteristic** of imatinib's adverse effect profile. - **Regular liver function monitoring** is required during imatinib therapy, and the FDA labeling includes hepatotoxicity warnings. - Among the listed options, this represents the **least predictable** adverse effect compared to the nearly universal fluid retention issues. *Periorbital edema* - **Fluid retention** with **periorbital edema** is the **most characteristic and common** adverse effect of imatinib, occurring in **60-70% of patients**. - This is due to imatinib's effect on **PDGF and c-KIT receptors** affecting vascular permeability and interstitial fluid regulation. - Often one of the first adverse effects patients notice. *Myalgia* - **Muscle aches and cramps** occur in **40-50% of patients** taking imatinib. - Often managed with **magnesium supplementation**, hydration, and dose adjustment. - Represents a very commonly reported musculoskeletal adverse effect. *Pleural effusion* - Part of the **fluid retention spectrum** associated with imatinib therapy. - Occurs in **5-10% of patients**, particularly with higher doses or in elderly patients. - May require dose reduction, diuretics, or temporary drug discontinuation in severe cases.

Q: Pemetrexed in combination with cisplatin is the first-line chemotherapy for which of the following conditions?

Mesothelioma. ***Mesothelioma*** - **Pemetrexed in combination with cisplatin** is the **first-line standard chemotherapy** for **malignant pleural mesothelioma**. - This was pemetrexed's **first FDA approval** (2004) and represents its most characteristic indication. - It acts as a **folate analog metabolic inhibitor**, targeting rapidly dividing cells. - Pemetrexed-cisplatin combination significantly improves survival compared to cisplatin alone in mesothelioma. *Non small cell lung carcinoma* - While pemetrexed is also approved for **non-squamous NSCLC**, it is used in various regimens (first-line with cisplatin/carboplatin, maintenance therapy, or second-line monotherapy). - However, in NSCLC, the pemetrexed-cisplatin combination is **one of several options**, not the definitive first-line standard as it is in mesothelioma. - The question specifically asks about the condition where pemetrexed-cisplatin is the **first-line standard**. *Ewings sarcoma* - **Ewing's sarcoma** is a bone cancer primarily affecting children and young adults. - Standard treatment involves **vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide**. - **Pemetrexed** is not used in Ewing's sarcoma treatment. *Osteosarcoma* - **Osteosarcoma** is treated with regimens involving **methotrexate, doxorubicin, cisplatin, and ifosfamide**. - **Pemetrexed** is not a standard component of osteosarcoma treatment protocols.

Q: Which drug specifically acts during the 'S' phase of the cell cycle?

Methotrexate. ***Methotrexate*** - This drug is an **antimetabolite** that acts as a **folate analog**, directly inhibiting **dihydrofolate reductase (DHFR)**. - By blocking DHFR, methotrexate prevents the synthesis of **thymidylate** and other **purine nucleotides**, essential components for DNA synthesis during the **S phase**. *Chlorambucil* - Chlorambucil is an **alkylating agent** that forms **covalent bonds** with DNA, leading to DNA damage and cross-linking. - Its action is **cell cycle non-specific**, meaning it can affect cells in various phases of the cell cycle, not exclusively the S phase. *Vincristine* - Vincristine is a **vinca alkaloid** that acts by binding to **tubulin**, thereby inhibiting its polymerization into **microtubules**. - This disruption prevents the formation of the **mitotic spindle**, arresting cells in **metaphase** during the **M phase** of the cell cycle. *Paclitaxel* - Paclitaxel belongs to the **taxanes** and functions by stabilizing **microtubules**, preventing their depolymerization. - This stabilization also leads to the arrest of cells in **metaphase** during the **M phase**, similar to vincristine but through a different mechanism (stabilizing rather than inhibiting formation).

Q: What is the preferred method for the disposal of cytotoxic drugs?

Incineration. ***Incineration*** - **High-temperature incineration** (typically 1,000°C to 1,200°C) is the most effective method for rendering cytotoxic drugs **harmless** by breaking down their chemical structure. - This method ensures the complete destruction of active cytotoxic compounds and minimizes environmental contamination. *Autoclaving* - **Autoclaving** uses high-pressure steam for sterilization, primarily effective against **microorganisms**, but it does not chemically inactivate cytotoxic drugs. - Many cytotoxic drugs are heat-stable and simply autoclaving them would not destroy their **pharmacological activity**. *Chemical disinfection* - **Chemical disinfection** methods are generally not sufficient to completely inactivate the complex chemical structures of most cytotoxic drugs. - Some cytotoxic agents can react with disinfectants to form other hazardous byproducts, or the disinfection process may not ensure **complete degradation**. *Microwaving* - **Microwaving** is primarily used for heating and has no significant role in the **destruction or inactivation** of cytotoxic compounds. - It does not generate the necessary temperatures or conditions to break down the chemical structure of **cytotoxic waste**.

Q: Mechanism of action of actinomycin D is ?

Inhibits DNA-dependent RNA synthesis. ***Inhibits DNA-dependent RNA synthesis*** - **Actinomycin D** (dactinomycin) is a chemotherapeutic agent that primarily acts by intercalating into the **DNA double helix** [1]. - This intercalation selectively inhibits the movement of **RNA polymerase**, thereby blocking **DNA-dependent RNA synthesis** (transcription) and subsequently protein synthesis [1]. *Inhibits RNA-dependent DNA synthesis* - This mechanism describes the action of drugs targeting **reverse transcriptase**, such as those used in **HIV treatment** [2]. - Actinomycin D does not affect enzymes involved in synthesizing DNA from an RNA template [1]. *Activates RNA-dependent DNA synthesis* - There are no known therapeutic drugs that deliberately activate **RNA-dependent DNA synthesis**. - Such an action would typically promote viral replication in the context of **retroviruses**. *Activates DNA-dependent RNA synthesis* - Activating **DNA-dependent RNA synthesis** (transcription) would increase gene expression and protein synthesis. - Actinomycin D is an **anti-cancer drug** designed to suppress cell growth by *inhibiting* this process, not activating it [1].

Q: Anticancer drug with disulfiram-like action?

Procarbazine. ***Procarbazine***- **Procarbazine** inhibits **aldehyde dehydrogenase**, leading to an accumulation of acetaldehyde when alcohol is consumed.- This accumulation results in symptoms similar to those experienced with **disulfiram-alcohol reactions**, such as flushing, headache, nausea, and vomiting.*Nitrosourea*- **Nitrosoureas** like carmustine and lomustine are **alkylating agents** that cross the blood-brain barrier and are primarily used in brain tumors. [1]- They do not exhibit a recognized disulfiram-like reaction with alcohol.*5 FU*- **5-Fluorouracil (5-FU)** is a **pyrimidine analog** that acts as an antimetabolite, interfering with DNA and RNA synthesis. [2]- While it has various side effects, a disulfiram-like reaction is not among its common or significant adverse drug interactions.*Methotrexate*- **Methotrexate** is an **antifolate drug** that inhibits dihydrofolate reductase, thereby blocking DNA synthesis. [2]- It is known for side effects like myelosuppression and mucositis but does not have disulfiram-like properties.

Q: Which of the following is an aromatase inhibitor?

Letrozole. ***Letrozole*** - **Letrozole** is a commonly used **aromatase inhibitor**, which works by blocking the enzyme **aromatase** that converts androgens into estrogens [1]. - This reduction in estrogen levels is crucial in treating **hormone-sensitive breast cancers** [1]. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)**, not an aromatase inhibitor [2]. - It acts by blocking estrogen receptors in breast tissue while potentially stimulating them in other tissues like bone and uterus [2]. *Danazol* - **Danazol** is a synthetic androgen that suppresses the hypothalamic-pituitary-gonadal axis, leading to **decreased estrogen production**. - It works by inhibiting gonadotropin release and directly inhibiting ovarian steroidogenesis, rather than blocking the aromatase enzyme directly. *Taxane* - **Taxanes** are a class of **chemotherapy drugs** that interfere with cell division by stabilizing microtubules. - They are used to treat various cancers, including breast cancer, but do not act as aromatase inhibitors.

Q: All of the following are known adverse effects of thalidomide, except:

Diarrhoea. ***Diarrhoea*** - **Diarrhoea** is generally *not* considered a common or significant adverse effect of thalidomide. Constipation is more frequently reported. - While individual reactions vary, thalidomide's primary adverse effect profile does not typically include diarrhoea. *Teratogenicity* - **Teratogenicity** is the most notorious adverse effect of thalidomide, causing severe birth defects like **phocomelia** (shortened or absent limbs) in infants exposed during pregnancy. - Due to this, stringent **risk evaluation and mitigation strategies (REMS)** are in place for thalidomide use. *DVT* - Thalidomide is known to increase the risk of **venous thromboembolism (VTE)**, including **deep vein thrombosis (DVT)** and pulmonary embolism, especially in patients with multiple myeloma. - Prophylactic anticoagulation is often recommended for patients receiving thalidomide, particularly in combination with corticosteroids. *Neuropathy* - **Peripheral neuropathy** is a common and dose-limiting adverse effect of thalidomide, often presenting as numbness, tingling, and pain in the hands and feet. - It can be progressive and potentially irreversible, requiring careful monitoring and dose adjustments.

Q: Which of the following drugs is not typically used for carcinoma of the head and neck?

Busulfan. ***Busulfan*** - **Busulfan** is an **alkylating agent** primarily used in the treatment of **chronic myeloid leukemia (CML)** and as a conditioning regimen before **stem cell transplantation**. - It is **not a standard chemotherapy agent** for head and neck squamous cell carcinoma. *5FU* - **5-fluorouracil (5FU)** is a **pyrimidine analog antimetabolite** commonly used in the treatment of head and neck cancers. - It works by interfering with **DNA and RNA synthesis**, making it an effective agent in combination with other drugs or radiation. *Cisplatin* - **Cisplatin** is a **platinum-based chemotherapy drug** that is a cornerstone in the treatment of head and neck squamous cell carcinoma. - It forms **DNA adducts**, leading to cell death, and is often used in combination with radiation or other chemotherapy agents. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits **dihydrofolate reductase**, thereby interfering with DNA synthesis. - It is frequently used in the treatment of head and neck cancers, particularly in the **recurrent or metastatic setting**.

Q: What is the primary indication for the use of Erlotinib?

NSCLC. ***NSCLC (Non-Small Cell Lung Cancer)*** - **Erlotinib** is primarily indicated for patients with advanced **non-small cell lung cancer (NSCLC)**, particularly those with activating mutations in the **epidermal growth factor receptor (EGFR)**. - It functions as an **EGFR tyrosine kinase inhibitor**, blocking the signaling pathways essential for cancer cell growth and survival. - This is the **FDA-approved primary indication** and where Erlotinib shows the most significant clinical benefit. *Pancreatic cancer* - While Erlotinib has been used in combination with gemcitabine for **locally advanced, unresectable or metastatic pancreatic cancer**, it is not its primary or most prominent indication. - Its efficacy in pancreatic cancer is generally modest and overshadowed by its dramatic impact in EGFR-mutated NSCLC. *Colon cancer* - **Erlotinib** is **not a primary treatment** for **colon cancer**. - Other targeted therapies (such as anti-EGFR monoclonal antibodies like cetuximab) or chemotherapy regimens are typically used for colorectal cancer. *Gall bladder cancer* - **Erlotinib** is generally **not indicated** for the treatment of **gallbladder cancer**. - Treatment often involves surgery, chemotherapy, or radiation, with targeted therapies being less established for this malignancy.

Question 1

Which of the following is not a commonly reported adverse effect of imatinib?

Accepted Answer

Hepatotoxicity

Answer

Myalgia

Answer

Periorbital edema

Answer

Pleural effusion

Question 2

Pemetrexed in combination with cisplatin is the first-line chemotherapy for which of the following conditions?

Accepted Answer

Mesothelioma

Answer

Non small cell lung carcinoma

Answer

Ewings sarcoma

Answer

Osteosarcoma

Question 3

Which drug specifically acts during the 'S' phase of the cell cycle?

Accepted Answer

Methotrexate

Answer

Chlorambucil

Answer

Vincristine

Answer

Paclitaxel

Question 4

What is the preferred method for the disposal of cytotoxic drugs?

Accepted Answer

Incineration

Answer

Autoclaving

Answer

Chemical disinfection

Answer

Microwaving

Question 5

Mechanism of action of actinomycin D is ?

Accepted Answer

Inhibits DNA-dependent RNA synthesis

Answer

Inhibits RNA-dependent DNA synthesis

Answer

Activates RNA-dependent DNA synthesis

Answer

Activates DNA-dependent RNA synthesis

Question 6

Anticancer drug with disulfiram-like action?

Accepted Answer

Procarbazine

Answer

Nitrosourea

Answer

5 FU

Answer

Methotrexate

Question 7

Which of the following is an aromatase inhibitor?

Accepted Answer

Letrozole

Answer

Tamoxifen

Answer

Danazol

Answer

Taxane

Question 8

All of the following are known adverse effects of thalidomide, except:

Accepted Answer

Diarrhoea

Answer

DVT

Answer

Neuropathy

Answer

Teratogenicity

Question 9

Which of the following drugs is not typically used for carcinoma of the head and neck?

Accepted Answer

Busulfan

Answer

Cisplatin

Answer

Methotrexate

Answer

5FU

Question 10

What is the primary indication for the use of Erlotinib?

Accepted Answer

NSCLC

Answer

Colon cancer

Answer

Gall bladder cancer

Answer

Pancreatic cancer

Anticancer Drugs — MCQs

Anticancer Drugs — MCQs

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