Anticancer Drugs — MCQs
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Drug of choice for palliative treatment of pancreatic carcinoma
Which of the following antineoplastic agents is primarily used in the management of small cell carcinoma of the lung?
Which of the following conditions is Cetuximab primarily used to treat?
Estramustine is a combination of ?
Which drug specifically acts during the 'S' phase of the cell cycle?
Pemetrexed in combination with cisplatin is the first-line chemotherapy for which of the following conditions?
Which of the following is the most characteristic adverse effect of cyclophosphamide?
What is the preferred method for the disposal of cytotoxic drugs?
Mechanism of action of actinomycin D is ?
Anticancer drug with disulfiram-like action?
Anticancer Drugs Indian Medical PG Practice Questions and MCQs
Question 551: Drug of choice for palliative treatment of pancreatic carcinoma
- A. Cyclophosphamide
- B. Erlotinib
- C. Gemcitabine (Correct Answer)
- D. Paclitaxel
Explanation: ***Gemcitabine*** - **Gemcitabine** is the cornerstone chemotherapy agent and standard **first-line drug of choice** for palliative treatment of advanced pancreatic cancer [1]. - It demonstrates significant **palliative benefits** by improving quality of life, clinical benefit response, and modest survival extension compared to 5-FU. - Its mechanism involves interfering with DNA synthesis as a nucleoside analog, leading to cell death in rapidly dividing cancer cells [1]. - For patients with good performance status, gemcitabine-based combination regimens (such as with nab-paclitaxel) may offer additional benefit, but gemcitabine remains the foundational agent. *Erlotinib* - **Erlotinib** is a tyrosine kinase inhibitor targeting the **epidermal growth factor receptor (EGFR)** [2]. - It may be used in combination with gemcitabine for advanced pancreatic cancer, but provides only modest additional benefit. - It is not the primary drug of choice for palliative treatment alone. *Paclitaxel* - **Paclitaxel** is a taxane chemotherapy agent; specifically, **nab-paclitaxel (albumin-bound paclitaxel)** is used in combination with gemcitabine as a first-line regimen for metastatic pancreatic cancer. - The nab-paclitaxel plus gemcitabine combination has shown superior outcomes compared to gemcitabine monotherapy in clinical trials. - However, as a single agent for palliative treatment, paclitaxel is not the drug of choice; gemcitabine remains the foundational agent. *Cyclophosphamide* - **Cyclophosphamide** is an alkylating agent used in various cancers like leukemia, lymphoma, and some solid tumors. - It has no established role in the treatment of pancreatic carcinoma and is not used for palliative therapy in this disease.
Question 552: Which of the following antineoplastic agents is primarily used in the management of small cell carcinoma of the lung?
- A. Cisplatin (Correct Answer)
- B. Bleomycin
- C. Paclitaxel
- D. Doxorubicin
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that is a cornerstone of treatment for **small cell lung carcinoma (SCLC)**, often used in combination with etoposide. - It works by forming **DNA adducts**, leading to cross-linking and inhibition of DNA synthesis, which is particularly effective against rapidly dividing SCLC cells. *Bleomycin* - **Bleomycin** is an antibiotic antineoplastic agent primarily used in germ cell tumors, lymphomas, and head and neck cancers, but not typically as a first-line agent for SCLC. - Its main dose-limiting toxicity is **pulmonary fibrosis**, which can be severe and is a significant concern. *Paclitaxel* - **Paclitaxel** is a **taxane** chemotherapy drug mainly used in non-small cell lung cancer, ovarian cancer, and breast cancer. - It stabilizes microtubules, preventing depolymerization, which leads to cell cycle arrest and apoptosis, but is not a primary agent for SCLC. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** used for various cancers including lymphomas, breast cancer, and sarcomas, but not a primary chemotherapy for SCLC. - Its significant side effect is **cardiotoxicity**, which can lead to congestive heart failure.
Question 553: Which of the following conditions is Cetuximab primarily used to treat?
- A. Basal cell carcinoma
- B. Crohn's disease
- C. Adamantinoma of bone
- D. Colorectal cancer (Correct Answer)
Explanation: ***Colorectal cancer*** - **Cetuximab** is an **epidermal growth factor receptor (EGFR) inhibitor** primarily used in the treatment of metastatic colorectal cancer. - It is particularly effective in patients with **RAS wild-type tumors**, as mutations in RAS can confer resistance to anti-EGFR therapies. *Basal cell carcinoma* - This is a **skin cancer** typically treated with local excision, topical therapies, or hedgehog pathway inhibitors like vismodegib or sonidegib. - **Cetuximab** is not a standard treatment for basal cell carcinoma. *Crohn's disease* - This is an **inflammatory bowel disease** treated with anti-inflammatory drugs, immunomodulators, and biologics like anti-TNF agents (e.g., adalimumab, infliximab). - **Cetuximab** targets EGFR and is not indicated for Crohn's disease. *Adamantinoma of bone* - This is a rare, low-grade malignant **bone tumor** that is typically treated with surgical resection. - There is no established role for **Cetuximab** in the management of adamantinoma.
Question 554: Estramustine is a combination of ?
- A. Estradiol + normustine (Correct Answer)
- B. Estriol + normustine
- C. Estriol + mechloroethamine
- D. Estriol + cyclophosphamide
Explanation: ***Estradiol + normustine*** - **Estramustine** is a **cytotoxic drug** used in the treatment of **prostate cancer**. - It is a chemical conjugate of **estradiol** (an estrogen) and **normustine** (a nitrogen mustard alkylating agent). *Estriol + normustine* - **Estriol** is a weaker estrogen compared to **estradiol** and is not the estrogen component in estramustine. - The combination of estriol with normustine does not form estramustine. *Estriol + mechloroethamine* - **Mechlorethamine** is another type of **nitrogen mustard** alkylating agent, but it is not the specific cytotoxic component of estramustine. - **Estriol** is also incorrect as the estrogen component. *Estriol + cyclophosphamide* - **Cyclophosphamide** is a different **alkylating agent** from the nitrogen mustards, and it is not part of the estramustine structure. - As with previous options, **estriol** is not the correct estrogen component.
Question 555: Which drug specifically acts during the 'S' phase of the cell cycle?
- A. Chlorambucil
- B. Methotrexate (Correct Answer)
- C. Vincristine
- D. Paclitaxel
Explanation: ***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).
Question 556: Pemetrexed in combination with cisplatin is the first-line chemotherapy for which of the following conditions?
- A. Non small cell lung carcinoma
- B. Ewings sarcoma
- C. Mesothelioma (Correct Answer)
- D. Osteosarcoma
Explanation: ***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.
Question 557: Which of the following is the most characteristic adverse effect of cyclophosphamide?
- A. Hemorrhagic cystitis (Correct Answer)
- B. Infertility
- C. Bone marrow suppression
- D. Diabetes insipidus
Explanation: ***Hemorrhagic cystitis*** - **Hemorrhagic cystitis** is a unique and characteristic adverse effect of cyclophosphamide due to the accumulation of its metabolite, **acrolein**, in the bladder. - This toxicity can be prevented by adequate hydration and co-administration of **mesna**. *Infertility* - While **cyclophosphamide** can cause **infertility** due to its cytotoxic effects on gonadal cells, this is a less specific and less immediate adverse effect compared to hemorrhagic cystitis. - Infertility is a common side effect of many chemotherapeutic agents, but hemorrhagic cystitis is particularly associated with **cyclophosphamide** and **ifosfamide**. *Bone marrow suppression* - **Bone marrow suppression**, leading to **myelosuppression** (leukopenia, anemia, thrombocytopenia), is a very common and expected dose-limiting toxicity of most chemotherapy drugs, including cyclophosphamide. - Although serious, it is not the most *characteristic* or unique adverse effect of cyclophosphamide in the way **hemorrhagic cystitis** is. *Diabetes insipidus* - **Diabetes insipidus** is not a known or characteristic adverse effect of cyclophosphamide. - Other drugs, such as **lithium**, are more commonly associated with nephrogenic diabetes insipidus.
Question 558: What is the preferred method for the disposal of cytotoxic drugs?
- A. Autoclaving
- B. Chemical disinfection
- C. Incineration (Correct Answer)
- D. Microwaving
Explanation: ***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**.
Question 559: Mechanism of action of actinomycin D is ?
- A. Inhibits RNA-dependent DNA synthesis
- B. Activates RNA-dependent DNA synthesis
- C. Inhibits DNA-dependent RNA synthesis (Correct Answer)
- D. Activates DNA-dependent RNA synthesis
Explanation: ***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].
Question 560: Anticancer drug with disulfiram-like action?
- A. Procarbazine (Correct Answer)
- B. Nitrosourea
- C. 5 FU
- D. Methotrexate
Explanation: ***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.
Practice by Chapter
Principles of Cancer Chemotherapy
Practice Questions
Alkylating Agents
Practice Questions
Antimetabolites
Practice Questions
Antitumor Antibiotics
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Plant Alkaloids
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Topoisomerase Inhibitors
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Hormonal Agents
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Targeted Therapy
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Immunotherapy
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Management of Chemotherapy Side Effects
Practice Questions
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