Pharm Antineoplastic Drugs Part 2
Welcome back to another chapter in our ongoing series of pharmacological quizzes on the topic of neoplasms, or tumours, and the pharmaceuticals used to prevent their development. What do you know about these antineoplastic drugs? Take the quiz right now and we’ll find out right now!
Questions and Answers
- 1.
A 42-year-old woman presented with fever, night sweats, cough and a 8 kg weight loss. Chest x-rays displayed a mediastinal mass and a CT scan of the abdomen showed multiple enlarged lymph nodes. A biopsy of an inguinal node revealed Reed-Sternberg cells. The patient was scheduled for a combination ABVD anticancer chemotherapy (doxorubicin, bleomycin vinblastine and dacarbazine). Which of the following malignancies was the patient most likely to suffer from?
- A.
Bladder cancer
- B.
Chronic myelogenous leukemia
- C.
Hodgkin’s disease
- D.
Acute lymphoblastic leukemia
- E.
Lung cancer
Correct Answer
C. Hodgkin’s diseaseExplanation
Answer: C
The results of lymph node biopsy confirm the diagnosis of Hodgkin’s disease. Reed-Steinberg cells are
giant connective tissue cells with one or two large nuclei. These cells are specific to are Hodgkin’s
lymphoma ad are therefore diagnostic markers of the disease. Hodgkin’s disease is classified in 4 stages
according to its extent. In the present case the disease is stage IV because of extranodal (mediastinal)
involvement.
Two 4 drug combination regimens have demonstrated equivalent long-term survival rates in advanced
Hodgkin’s disease. These regimens are the MOPP regimen (mechlorethamine, vincristine procarbazine
and prednisone) and the ABVD regimen. However the MOPP regimen is associated with a higher risk of
toxicity and therefore the ABVD regimen is currently the preferred one.
A, B, D, E) These malignancies do not show Reed-Sternberg cells and are not treated with the ABVD
regimen.Rate this question:
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- 2.
A 6-year-old girl with acute lymphoblastic leukemia completed her induction therapy with a multidrug regimen. Now she is scheduled for maintenance therapy with a regimen that includes a CCS anticancer drug administered daily, for 7 days every 4 weeks. Which of the following is the drug she is about to receive?
- A.
Cyclophosphamide
- B.
Doxorubicin
- C.
Mercaptopurine
- D.
Cisplatin
- E.
Carmustine
Correct Answer
C. MercaptopurineExplanation
Answer: C
Maintenance therapy of acute lymphoblastic leukemia is usually performed for 2.5-3 years after
remission since early trials have shown that, without maintenance, most children will relapse within 1 or 2
months. Impressive improvements in disease-free survival are achieved with various maintenance
regimens. Methotrexate and mercaptopurine are the drugs most often included in these regimens.
Mercaptopurine is effective and well tolerated orally when administered daily.
A, B, D, E) All these drugs are NCCS.Rate this question:
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- 3.
A 39-year-old man with acute lymphoblastic leukemia was admitted to the hospital for remission chemotherapy. After three week of therapy the patient started complaining of numbness of his fingers and the soles of his feet. Physical examination showed loss of ankle jerk and depression of deep tendon reflexes. Which of the following drugs most likely caused these patient’s signs and symptoms?
- A.
Vincristine
- B.
Prednisone
- C.
Methotrexate
- D.
Mercaptopurine
- E.
Doxorubicin
Correct Answer
A. VincristineExplanation
Answer: A
The patient paresthesias and loss of reflexes are signs of vincristine peripheral neuropathy, which often
appears within the first few weeks of therapy. Areflexia is common in patients treated with high
cumulative doses. Vinca alkaloids have certain toxicities in common (i.e. nausea and vomiting, diarrhea,
alopecia) but other adverse effects differ. Vincristine causes a dose-limiting neurotoxicity but is a mild
myelosuppressant, whereas vinblastine causes negligible neurotoxicity but gives rise to a severe, doselimiting
myelosuppression.
B, C, D, E) The risk of peripheral neuropathy with these drugs is negligible.Rate this question:
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- 4.
A 56-year-old woman with a long history of heavy smoking, presented with cough ,fever, chest pain and bloody sputum. A chest x-ray revealed a 3.5 cm hilar mass and a transbronchial biopsy specimen showed infiltrating groups of anaplastic small cells with hyperchromatic nuclei and no nucleoli. Which of the following drugs was most likely included in the therapeutic regimen of this patient?
- A.
Isoniazid
- B.
Ceftazidime
- C.
Streptomycin
- D.
Asparaginase
- E.
Etoposide
Correct Answer
E. EtoposideExplanation
Answer: E
The symptoms of the patient and the bronchial biopsy are consistent with the diagnosis of a small cell
lung cancer. Although the risk of developing any type of lung cancer increases with cigarette smoking,
the relative risk of small cell lung cancer is among the highest. The cell of these cancers, also called ‘oat
cell’ carcinomas, contain a scanty amount of cytoplasm and rarely have nucleoli. These malignancies,
which are of neuroendocrine origin, may cause a variety of paraneoplastic syndromes due to the
synthesis and secretion of hormones such as ACTH and serotonin. Small cell lung cancers carry a poor
prognosis since they metastasize early and are already spread at the time of diagnosis. Etoposide, given
together with a platinum compound, has been shown to improve significantly survival and is today a drug
of choice in this disease.
A, B, C) These drugs are antimicrobial agents and are therefore of no value in lung cancer.
D) Asparaginase is an anticancer drug used in childhood lymphoblastic leukemia.Rate this question:
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- 5.
A 45-year-old man presented to the hospital with increasing weakness and decreased exercise tolerance. A CBC showed a WBC count of 50000/mm 3 with 90% neutrophils and a platelet count of 1200000/mm3. Chromosomal studies on a bone marrow aspirate found the present of a Philadelphia chromosome. Which of the following drugs was most likely included in the patient chemotherapeutic regimen?
- A.
Hydroxyurea
- B.
Rifampin
- C.
Metronidazole
- D.
Ciprofloxacin
- E.
Isoniazid
Correct Answer
A. HydroxyureaExplanation
Answer: A
The WBC count and the presence of the Philadelphia chromosome confirm the diagnosis of chronic
myelogenous leukemia. The disease ( which is associated with the Philadelphia chromosome in over
90% of cases) is characterized by increased granulocytes in peripheral blood and often increased
platelets in early stages, as in the present case. The goal of chemotherapy in chronic myelogenous
leukemia is to reduce leukocytosis and its associated symptoms. Hydroxyurea is still the most common
agent used for leucocyte reduction. However interferon-alpha and the monoclonal antibody imatinib
seem to give better results in term of remission and 5 year survival.
B, C; D, E) All these agents are antibacterial, not anticancer, drugs.Rate this question:
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- 6.
A 66-year-old man came to his physician complaining of a persistent backache. He was found on rectal examination to have a single, hard, irregular nodule within his prostate. Subsequent exams found his prostatic specific antigen to be 100 ng/mL ( normal: < 3.0 ) and a CT scan showed several enlarged pelvic lymph nodes and multiple sclerotic lesions in his spine. Which of the following pairs of drugs would be most appropriate for that patient?
- A.
Paclitaxel and cisplatin
- B.
Vincristine and prednisone
- C.
Leuprolide and flutamide
- D.
Tamoxifen anastrozole
- E.
Vincristine and dactinomycin
Correct Answer
C. Leuprolide and flutamideExplanation
Answer: C
The signs of the patient strongly suggest a prostate cancer and the exam results confirm the diagnosis
of prostatic carcinoma. The PSA is the most used lab test for early detection of prostate cancer, and
spine metastases with prevalent necrotic lesions are the most common metastases of prostatic
carcinoma. The mainstay of treatment for metastasized prostate cancer is hormonal therapy. Since the
cancer is testosterone dependent, hormonal manipulation is centered to reduce testosterone levels.
Leuprolide is a synthetic GnRH analog. When administered daily (or as a depot preparation) to maintain
stable blood levels, it inhibits the release of FSH and LH, likely due to down-regulation of pituitary
receptors. This inhibition strongly reduces testicular androgen synthesis. Flutamide is a androgen
receptor antagonist. Combined treatment with these two drugs reduces symptoms in 70-80% of patients,
causes an appreciable regression of established metastases and prolongs survival. On the contrary
cytotoxic chemotherapy failed to prolong survival in patient with advanced prostate cancer.
A) This is the most common therapy for advanced ovarian cancer.
B) This is the most common therapy for acute lymphoblastic leukemia.
D) These drugs are used in hormone receptor positive breast cancer.
E) These drugs are used in Wilms tumor.Rate this question:
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- 7.
A 62-year-old woman with advanced Hodgkin’s disease is to begin chemotherapy with the ABVD regimen (doxorubicin, bleomycin vinblastine and dacarbazine). Which of the following statements best explains the mechanism of anticancer action of doxorubicin?
- A.
It intercalates between DNA strands and inhibit topoisomerase II
- B.
It prevent microtubule disassembly into tubulin monomers
- C.
It prevents assembly of tubulin dimers into microtubules
- D.
It alkylates nucleophilic groups on DNA bases
- E.
It blocks the synthesis of both ribonucleotides and deoxynucleotides
Correct Answer
A. It intercalates between DNA strands and inhibit topoisomerase IIExplanation
Answer: A
Doxorubicin is an anthracycline antibiotic. These anticancer drugs likely act by multiple mechanisms
including the following :
1) They can intercalate between adjacent base pairs of DNA so causing blockade of DNA replication.
2) They block topoisomerase II, the enzyme which catalyzes DNA repair.(it breaks and then reseals DNA
strands).
3) They generate free radicals which can oxidize DNA bases.
The end result of these multiple mechanisms is cell apoptosis.
B) This would be the mechanism of action of taxanes
C) This would be the mechanism of action of Vinca alkaloids
D) This would be the mechanism of action of alkylating drugs
E) This would be the mechanism of action of methotrexate.Rate this question:
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- 8.
A 3 year-old boy diagnosed with a favorable histology Wilms’ tumor underwent surgery followed by 18 week of vincristine and dactinomycin therapy. Which of the following statement best explains the mechanism of action of dactinomycin?
- A.
It alkylates nucleophilic groups on RNA bases
- B.
It inhibit dihydrofolate reductase
- C.
It inhibits pyrimidine biosynthesis
- D.
It binds to double-stranded DNA so inhibiting DNA transcription
- E.
It inhibits free radical formation
Correct Answer
D. It binds to double-stranded DNA so inhibiting DNA transcriptionExplanation
Answer: D
Dactinomycin is a cytotoxic antibiotic. Its main mechanism of anticancer action involves binding to
double-helical DNA so preventing DNA transcription and RNA synthesis. Dactinomycin is used mainly in
Wilms’ tumor, a kidney tumor that is the most common intra-abdominal tumor of childhood and accounts
of about 6% of all childhood malignancies.
A) This is the mechanism of action of alkylating drugs
B) This is the mechanism of action of methotrexate
C) This is the mechanism of action of pyrimidine analogs
E) The formation, not the inhibition, of free radical is one of the postulated mechanisms of action of
some anticancer drugs including doxorubicin and bleomycin.Rate this question:
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- 9.
A 42-year-old man with stage III Hodgkin’s disease received six courses of chemotherapy with the ABVD regimen. Which of the following drugs of this regimen acts mainly in the G2 phase of the tumor cell cycle?
- A.
Doxorubicin
- B.
Bleomycin
- C.
Vinblastine
- D.
Dacarbazine
Correct Answer
B. BleomycinExplanation
Answer: B
Bleomycin is the only cytotoxic antibiotic that is CCS. It has been shown that the drug causes
accumulation of cells in the G2 phase of the cell cycle
A, D) These drugs are CC NS
C) Vinblastine is CCS but act in the M phase of the cell cycle.Rate this question:
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- 10.
A 4-year-old girl presented with increasing weakness and bleeding gums. Physical examination revealed hepatospenomelaly. A CBC with differential showed a WBC count of 65000 with 43% lymphoblasts and a bone marrow biopsy revealed 92% lymphoblasts. The girl received systemic remission chemotherapy and also intrathecal chemotherapy in order to prevent relapse within the CNS. Which of the following drugs was most likely injected intrathecally?
- A.
Cisplatin
- B.
Paclitaxel
- C.
Etoposide
- D.
Bleomycin
- E.
Methotrexate
Correct Answer
E. MethotrexateExplanation
Answer: E
The blood exam and the bone marrow biopsy are consistent with the diagnosis of acute lymphoblastic
leukemia. Before CNS preventive therapy was routine, the CNS was the most common site of leukemic
relapse in children with acute lymphoblastic leukemia. Today preventive therapy is performed with
intracranial irradiation and intrathecal administration of anticancer drugs. Methotrexate (with or without
cytarabine and corticosteroids) is the most common drug administered intrathecally to prevent relapse.
A, B, C. D) these drugs are not currently used to treat acute lymphoblastic leukemia and are not
administered intrathecally.Rate this question:
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- 11.
A 45-year-old woman, who had undergone a radical mastectomy for infiltrating ductal carcinoma, started adjuvant combination therapy with CMF (cyclophosphamide, methotrexate and fluorouracil). Which of the following statements best explains the mechanism of action of methotrexate?
- A.
Inhibition of purine and pyrimidine biosynthesis
- B.
Inhibition of DNA chain elongation
- C.
Inhibition of ribonucleotide reductase
- D.
Inhibition of topoisomerase II
- E.
Inhibition of microtubule assembly
Correct Answer
A. Inhibition of purine and pyrimidine biosynthesisExplanation
Answer: A
Methotrexate is a folic acid antagonist that inhibits dihydrofolate reductase, the enzyme responsible for
the reduction of dihydrofolate to tetrahydrofolate. The drug is biotransformed intracellularly to
polyglutamated derivatives that are selectively retained within cancer cells and have a higher inhibitory
effect on the enzyme. The inhibition of dihydrofolate reductase leads to a decreased synthesis of
tetrahydrofolate, which is a one carbon unit carrier. These one carbon units are used in the synthesis of
purine and pyrimidine, which in turn are essential for the synthesis of DNA and RNA.
B) This is the mechanism of action of cytarabine.
C) This is the mechanism of action of hydroxyurea .
D) This is the mechanism of action of etoposide.
E) This is the mechanism of action of Vinca alkaloids .Rate this question:
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- 12.
A 32-year-old man presented to the hospital with increasing fatigue, anorexia, weight loss. and widespread ecchymoses. A blood examination revealed a white blood cell count of 70000/mm3 with 90% myeloblasts and a bone marrow biopsy showed blast cells that made up about 40% of the nucleated cells in the marrow (normal < 5%). Which of the following drugs was most likely included in the initial chemotherapy of this patient?
- A.
Cisplatin
- B.
Paclitaxel
- C.
Bleomycin
- D.
Cytarabine
- E.
Fluorouracil
Correct Answer
D. CytarabineExplanation
Answer: D
The blood exam and the bone marrow biopsy are consistent with the diagnosis of acute myelogenous
leukemia. This leukemia primarily affects adults (the incidence increases with age) and is characterized
by the neoplastic proliferation of myeloblasts. This leukemia primarily affects adults (the incidence
increases with age) and is characterized by the neoplastic proliferation of myeloblasts. The single most
active agent for acute myeloid leukemia is cytarabine. For remission therapy cytarabine is currently used
together with an anthracycline (idarubicin or daunorubicin).
A, B, C, E) These drugs are not currently used in the remission therapy of acute myelogenous leukemiaRate this question:
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- 13.
A 67-year-old man underwent surgery to remove an adenocarcinoma of the colon. Since the regional lymph nodes showed evidence of tumor involvement, adjuvant therapy was initiated after surgery. Which of the following drugs was most likely included in the therapeutic regimen of this patient?
- A.
Cytarabine
- B.
Fludarabine
- C.
Asparaginase
- D.
Hydroxyurea
- E.
Fluorouracil
Correct Answer
E. FluorouracilExplanation
Answer: E
Because of significant relapse rate in patients with extensive colon cancer, adjuvant therapy is usually
performed in those patients who underwent potential curative surgery, since it has been shown to
improve disease-free survival. Fluorouracil plus leucovorin given for 6 months is the most commonly
used regimen. Leucovorin is given because it has been shown that, by increasing the intracellular
concentration of a reduced folate (i.e. leucovorin), the formation of a stable complex between the
fluorouracil metabolite, the reduced folate and the thymidylate synthetase will be favored, so increasing
the cytotoxicity of fluorouracil.
A, B, C, D) These drugs are all CCS and are mainly used in tumors with a high grow fraction. They are
not currently used in the post surgical therapy of colon cancer, a tumor with low growth fractionRate this question:
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- 14.
A 45-year-old man recently diagnosed with small cell lung cancer starts his first course of combination chemotherapy with cisplatin, topotecan and etoposide. Which of the following peripheral blood cells will decrease first in this patient?
- A.
Lymphocytes
- B.
Platelets
- C.
Monocytes
- D.
Granulocytes
- E.
Erythrocytes
Correct Answer
D. GranulocytesExplanation
Answer: D
The decrease of peripheral blood cells after cancer chemotherapy depends upon the life span of that cell
line. The life span of granulocytes, once released from the bone marrow, is 4-5 hours in the blood and
another 4-5 days in the tissues. Platelets survive about 10 days. Therefore myelosuppression first results
in granulocytopenia followed by thrombocytopenia
A) Lymphocytes continually circulate throughout the body and have life spans of weeks, months or even
years.
B) (See explanation above)
C) Monocytes, once in the tissues, become macrophages and can live for months or even years.
E) Erythrocytes have a life span of about 120 daysRate this question:
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- 15.
A 32-year-old man, recently diagnosed with acute myelogenous leukemia, received a standard remission chemotherapy with daunorubicin and cytarabine. Drug dosage was maximized to a toxicity limit of a 2-log decrease in blood platelets. Which of the following represents the percentage of platelets killed by the drug regimen?
- A.
99.9%
- B.
99%
- C.
90%
- D.
80%
- E.
70%
Correct Answer
B. 99%Explanation
Answer: B
(Golan, pp 499, Koda-Kimble, pp 88-15)
The therapeutic strategy adopted in this case is based on the ‘log kill’ rule. This rule states that a given
dose of an anticancer drug will kill a constant proportion (not a constant number) of the tumor cell
population. In other words, killing by anticancer drugs is a first order process, and the curve representing
the number of killed cells with increasing dose of an anticancer drug is an exponential curve. This curve
can be transformed into a straight line by plotting the logarithm of the number of killed cells against the
dose. Remembering that the logarithm is the exponent required to produce a given number, it follows
that 1 is the log of 10 , 2 is the log of 10 (that is 100), 1 2 3 is the log of 103 (that is 1000) and so on.
Therefore if a population of 103 tumor cells is reduced to 102 tumor cells it can be said that it is reduced
by 1 log. This means that 900 cells are killed by the drug, resulting in a 90% decrease of cell number.
Accordingly a 2 log decrease means that 99% of the cells are killed, a 3 log decrease that 99.9% of the
cells are killed, and so on. Usually a 2 log decrease is the strategy most often used since a higher
decrease would produce unacceptable toxicity on healthy dividing cells.Rate this question:
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- 16.
A 50-year-old woman, recently diagnosed with ovarian cancer, started her first cycle of . combination chemotherapy with paclitaxel, cisplatin and cyclophosphamide. Which of the following drugs should also be administered in order to counteract a specific adverse effect of cyclophosphamide?
- A.
Erythropoietin
- B.
Leucovorin
- C.
MESNA (2-mercaptoethane sulfonate)
- D.
Acetylcysteine
- E.
Vitamin K
Correct Answer
C. MESNA (2-mercaptoethane sulfonate)Explanation
Answer: C
Cyclophosphamide can cause a hemorrhagic cystitis which seems to be due mainly to acrolein, an active
metabolite. Prevention consists of providing adequate IV hydration and administration of MESNA (2-
mercaptoethane sulfonate) that is thought to work by inactivating acrolein.
A, B, D, E) All these drugs cannot prevent cyclophosphamide-induced hemorrhagic cystitis.Rate this question:
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- 17.
A 75-year-old man recently diagnosed with chronic lymphocytic leukemia started a treatment with chlorambucil. Which of the following statements best explains the mechanism of action of this anticancer drug?
- A.
Formation of covalent bonds with nucleophile groups on DNA bases
- B.
Inhibition of DNA chain elongation
- C.
Inhibition of thymidylate synthetase
- D.
Prevention of resealing of nicked strands of DNA
- E.
Inhibition of microtubule assembly
Correct Answer
A. Formation of covalent bonds with nucleopHile groups on DNA basesExplanation
Answer: A
For many years chlorambucil (with of without prednisone) has been the standard treatment of chronic
lymphocytic leukemia. Recently comparisons of fludarabine with chlorambucil has demonstrated that
fludarabine improves progression-free survival, but not overall survival Chlorambucil, a nitrogen mustard,
belongs to the class of alkylating agents. These drugs act by intramolecular cyclization, to form either an
ethyleneimonium or a carbonium ion which are strongly electrophile (i.e. electron attracting). These
intermediates can alkylate, that is can transfer alkyl groups, to various cellular constituents by formation
of covalent bonds with nucleophile (i.e. electron donor) groups of these constituents. Alkylation of
guanine of a single strand of the DNA molecule results in miscoding or in depurination by excision of
guanine residues. Alkylation of guanine of both strands of the DNA molecule results in cross-linking,
which appears to be of major importance to the cytotoxic action of alkylating agents.
B) This is the mechanisms of action of cytarabine
C) This is the mechanisms of action of fluorouracil
D) This is the mechanisms of action of topoisomerase inhibitors
E) This is the mechanisms of action of Vinca alkaloidsRate this question:
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- 18.
A 52-year-old woman recently diagnosed with malignant glioblastoma received radiation therapy followed by a cycle of combination therapy which included carmustine. Which of the following statements best explains why this anticancer drug is most often used to treat CNS neoplasms?
- A.
It inhibits only tumor cells which originate from neurons
- B.
It is highly lipid soluble and therefore can easily enter the brain
- C.
Has negligible neurological adverse effects
- D.
It is uptaken into the nerve terminals by the amine pump
- E.
It is biotransformed into active metabolites in the brain only
Correct Answer
B. It is highly lipid soluble and therefore can easily enter the brainExplanation
Answer: B
Carmustine belongs to nitrosoureas. These alkylating agents have a high lipophilicity that facilitates their
entry into the brain. In fact their concentration in the CSF are 15-30% of the concurrent plasma values.
Because of this, nitrosoureas are mainly used in the treatment of brain tumors.
A) Nitrosoureas are CC NS agents that actually may kill most neoplastic and non neoplastic cells.
C) Carmustine actually can cause encephalopathy, when given in high doses.
D) The amine pump is specific for monoamines. Nitrosoureas are not monoamines.
E) Nitrosoureas undergo a spontaneous degradation in most body fluids, with formation of active
metabolites which alkylate DNARate this question:
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- 19.
A 10-year-old boy recently diagnosed with neuroblastoma, received his first course of combination chemotherapy. Now he complains of tinnitus and earing loss. Which of the following drugs most likely caused these symptoms?
- A.
Cisplatin
- B.
Vincristine
- C.
Doxorubicin
- D.
Dactinomycin
- E.
Cyclophosphamide
Correct Answer
A. CisplatinExplanation
Answer: A
Ototoxicity, characterized by a progressive hearing loss, commonly occurs with cisplatin and appears to
be more pronounced in children. The reversibility of this ototoxicity is questionable and it seems
substantial only with early cessation of cisplatin. Ototoxicity does not appear to be associated with other
platinum analogs (carboplatin, oxaliplatin).
B, C, D, E) The risk of ototoxicity with these drugs is negligible.Rate this question:
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- 20.
A 50-year-old woman underwent surgical operation to resect an ovarian carcinoma. Following surgery she started her first course of combination chemotherapy in order to eradicate the remaining tumor cells. Which of the following pairs of drugs were most likely included in her combination regimen?
- A.
Mercaptopurine and asparaginase
- B.
Methotrexate and hydroxyurea
- C.
Cytarabine and prednisone
- D.
Cisplatin and paclitaxel
- E.
Methotrexate and tamoxifen
Correct Answer
D. Cisplatin and paclitaxelExplanation
Answer: D
Ovarian cancer is the fifth most common cause of cancer and cancer death in women. Since the cancer
is relatively asymptomatic usually it has extended beyond the pelvis at the time of diagnosis. Therefore
chemotherapy is indicated after surgery. Cisplatin or carboplatin plus paclitaxel is the first-line regimen
most commonly used in ovarian cancer.
A, B, C, E) These drugs are not used to treat ovarian cancer.Rate this question:
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Mar 21, 2023Quiz Edited by
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