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Cancer and Immune System Pharmacology

Questions

Cell cycle, cell cycle specificity

Alkylating agents

Anticancer hormones and their antagonists

Antitumor antibiotics

Antimetabolites

Plant alkaloids

Immunomodulators

462. While reviewing charts in a general medicine clinic you see that a patient, 55-year-old and with no history of cancer at all, is taking methotrexate (MTX). What is the most likely condition for which this “anticancer drug” is being given?

a. Asthma or emphysema

b. Hyperthyroidism

c. Hyperuricemia or clinical gout

d. Myasthenia gravis

e. Rheumatoid arthritis or psoriasis

463. A 47-year-old woman with choriocarcinoma is treated with methotrexate (MTX), given at dosages that you believe may cause significant host cell toxicity. Which drug would you give to limit the toxic effects of the drug on normal host cells?

a. Deferoxamine

b. Leucovorin

c. N-acetylcysteine

d. Penicillamine

e. Vitamin K

464. You order vincristine, the prototype of the vinca alkaloids, to a patient with a tumor that is likely to be responsive to this drug. What is the most likely adverse response to this drug?

a. Nephrotoxicity, renal dysfunction or failure

b. Neutropenia

c. Peripheral sensory and motor neuropathy

d. Pulmonary damage

e. Thrombocytopenia, bleeding

465. A cancer patient develops severe, irreversible cardiomyopathy because the maximum lifetime dose of an anticancer drug was exceeded. What drug was most likely responsible for this?

a. Asparaginase

b. Bleomycin

c. Cisplatin

d. Cyclophosphamide

e. Doxorubicin

f. Vincristine

466. A patient with Wilms tumor is receiving a chemotherapeutic agent that is described as working by intercalating into DNA strands, and that is efficacious regardless of which stage of the cell cycle the tumor cells are in. Which drug best fits this description?

a. Anastrozole

b. Cytarabine (cytosine arabinoside)

c. Doxorubicin

d. Fluorouracil

e. Tamoxifen

467. A 42-year-old woman is diagnosed with metastatic breast cancer. You consider use of tamoxifen, toremifene, or fulvestrant. Why might fulvestrant be the best choice, all other factors being equal?

a. Exerts antiplatelet, rather than thrombotic, effects

b. Lacks ability to cause hot flashes or other disturbing side effects

c. Lower risk of causing endometrial cancer

d. Provides clinical cure, rather than palliation, in all patients

e. Significantly improves mineral density in, strength of, long bones

468. A patient with chronic myelogenous leukemia (CML) is being treated with imatinib. Which side effect or other situation should you anticipate in response to imatinib therapy?

a. A high rate of therapeutic failure, and the need to switch to interferonsα-2a and -2b

b. Hypotension and hypovolemia due to significant drug-induced diuresis

c. Interactions with other drugs that depend on or affect the cytochrome P450 system

d. Significant toxicity to normal host cells due to profound inhibition of tyrosine kinase

e. Thrombocytosis, with a high risk of intravascular clotting

469. As a rule, large (and older) solid tumors are more difficult to eradicate when chemotherapy is started. Which tumor-based property explains best the reason for this chemotherapeutic limitation?

a. Growth fraction slows, more cells enter G₀

b. Higher tumor blood flow washes away anticancer drugs faster

c. P-glycoprotein activity decreases as tumors get older

d. Their higher metabolic rate makes them less vulnerable to chemotherapeutic agents

e. Topoisomerase activity (ability to self-repair DNA strand damage) increases with tumor size

470. A man has prostate cancer that will be treated with leuprolide. Which drug are you most likely to use adjunctively when starting chemotherapy?

a. An aromatase inhibitor (eg, anastrozole)

b. Flutamide

c. Prednisone or another potent glucocorticoid

d. Tamoxifen

e. Testosterone

471. As part of the treatment plan for a Hodgkin disease patient we have given mechlorethamine. Which phrase best describes the anticancer mechanism of action of this drug?

a. Alkylates DNA, causing cross-links between parallel DNA strands

b. Blocks microtubular assembly and mitosis during M-phase

c. Inhibits topoisomerase, preventing repair of DNA strand breaks

d. Intercalates in DNA strands, thereby preventing DNA replication by mRNA

e. Stabilizes microtubular arrays, thereby preventing mitosis

472. The oncology team has treated many patients with acute lymphocytic leukemia using a combination of drugs. One drug tends to cause a high incidence of lumbar and abdominal pain, significant increases of plasma amylase and transaminase activity, and other symptoms of hepatic and/or pancreatic dysfunction. Some patients developed serious hypersensitivity reactions upon drug administration, and there have been occasional sudden deaths. Which drug best fits this description?

a. Asparaginase

b. Azathioprine

c. Doxorubicin

d. Methotrexate

e. Vincristine

473. A 30-year-old woman being treated for ovarian cancer develops high frequency hearing loss and declining renal function in response to anticancer drug therapy. Which drug is the most likely cause?

a. Bleomycin

b. Cisplatin

c. Doxorubicin

d. 5-Fluorouracil

e. Paclitaxel

474. A 41-year-old woman comes to the outpatient area of the hematology-oncology center for her first course of adjuvant chemotherapy for metastatic breast cancer following a left modified radical mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma of the breast. Two biopsies were positive for cancer.

Following premedication with dexamethasone and ondansetron, she will receive combination chemotherapy with doxorubicin, cyclophosphamide, and fluorouracil. Twenty-four hours after the first course of chemotherapy she will start a 10-day regimen with filgrastim. What is the most likely reason for administering the filgrastim?

a. Control of nausea and emesis

b. Potentiate the anticancer effects of the chemotherapeutic agents

c. Prevent doxorubicin-induced cardiotoxicity

d. Reduce the risk/severity of chemo-induced neutropenia, and related infections

e. Stimulate the gastric mucosa to repair damage caused by the chemotherapy drugs

475. A cancer patient receives prophylactic allopurinol before a course of chemotherapy. What is the main reason for giving the allopurinol?

a. Facilitate host cell detoxification of the chemotherapeutic drug, thereby reducing host cell toxicities

b. Inhibit the potential for DNA repair, by topoisomerases, that otherwise might lead to chemotherapy failure

c. Potentiate the action of a nitrogen mustard or nitrosourea to bind to (cross-link) purine moieties in DNA strands

d. Prevent myelosuppression and related blood dyscrasias

e. Reduce the risk of hyperuricemia and its main consequences (renal damage, gout) that can occur with a massive cell kill

476. The FDA requires manufacturers of an anticancer drug to avoid concomitant administration of certain SSRI antidepressants (fluoxetine, paroxetine, and sertraline) to woman receiving a particular anticancer drug. The drug in question is mainly used to treat certain types of breast cancers and is also used to prevent breast cancer recurrence. It commonly causes hot flashes and is associated with a high incidence of nausea and vomiting. The SSRIs listed above are strong inhibitors of CYP2D6 and so they can interfere with the anticancer drug’s metabolic activation, which is required for their chemotherapeutic effects. Which drug is the most likely target of interactions with these SSRIs?

a. Bleomycin

b. Interferon alpha

c. Mercaptopurine

d. Tamoxifen

e. Vinblastine

477. Allopurinol or the newer related drug febuxostat is commonly administered before initiating chemotherapy of leukemias and other blood-based cancers to prevent hyperuricemia and its consequences. It is also important in preventing hyperuricemia in response to chemotherapy of some solid tumors. However, it may potentiate the host toxicity of certain anticancer drugs by inhibiting their metabolic inactivation and detoxification. With which drug should concomitant use of allopurinol or febuxostat be avoided?

a. Bleomycin

b. Cisplatin

c. Cyclophosphamide

d. Doxorubicin

e. Mercaptopurine

478. A 48-year-old patient was in renal failure, but fortunately she received a kidney transplant. We start her on cyclosporine to reduce the risk of graft rejection. What are the most common and worrisome adverse responses associated with this immunosuppressant?

a. Cardiotoxicity and hepatotoxicity

b. Hepatotoxicity and nephrotoxicity

c. Hypotension and pulmonary fibrosis

d. Nephrotoxicity and infection risk

e. Thrombosis and pulmonary embolism or ischemic stroke

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