Head and neck cancer: therapeutic approaches MCQs With Answer

Introduction: This quiz collection on “Head and neck cancer: therapeutic approaches MCQs With Answer” is tailored for M.Pharm students preparing for Pharmacotherapeutics II (MPP 202T). It focuses on systemic and adjunctive treatments, mechanisms of action, dosing principles, radiosensitization, targeted and immune therapies, toxicity management, and supportive care specific to head and neck squamous cell carcinoma and related malignancies. Questions emphasize pharmacology, clinical rationales, and evidence-based decision-making—important for pharmacists involved in oncology care, dosing adjustments, adverse event mitigation, and multidisciplinary treatment planning. These MCQs aim to deepen understanding and prepare students for clinical and exam scenarios in head and neck cancer therapy.

Q1. Which cytotoxic mechanism best describes cisplatin’s primary antitumor action in head and neck cancer?

• Inhibition of topoisomerase II causing DNA strand breaks
• Alkylation of guanine leading to O6-methylguanine adducts
• Formation of intra- and interstrand DNA crosslinks via platinum–DNA adducts
• Antimetabolite inhibition of thymidylate synthase

Correct Answer: Formation of intra- and interstrand DNA crosslinks via platinum–DNA adducts

Q2. The standard high‑dose cisplatin schedule commonly used as a radiosensitizer in curative chemoradiation for locally advanced head and neck cancer is:

• Cisplatin 20 mg/m2 weekly during radiotherapy
• Cisplatin 100 mg/m2 every three weeks for 3 cycles concurrent with radiotherapy
• Cisplatin 50 mg/m2 on day 1 only before radiotherapy
• Continuous daily low‑dose cisplatin infusion throughout radiotherapy

Correct Answer: Cisplatin 100 mg/m2 every three weeks for 3 cycles concurrent with radiotherapy

Q3. The induction TPF regimen used in some head and neck cancer protocols consists of which combination?

• Taxane (docetaxel) + platinum (cisplatin) + fluorouracil (5‑FU)
• Platinum (carboplatin) + paclitaxel + cetuximab
• 5‑FU + methotrexate + bleomycin
• Cyclophosphamide + doxorubicin + vincristine

Correct Answer: Taxane (docetaxel) + platinum (cisplatin) + fluorouracil (5‑FU)

Q4. Cetuximab enhances radiotherapy efficacy primarily by which mechanism in head and neck cancer?

• Blocking VEGF-mediated angiogenesis to reduce tumor hypoxia
• Antagonizing EGFR extracellular domain to inhibit downstream proliferation and enhance radiosensitivity
• Inhibiting PD-1/PD-L1 interaction to restore antitumor immunity
• Directly crosslinking DNA to augment radiation-induced DNA damage

Correct Answer: Antagonizing EGFR extracellular domain to inhibit downstream proliferation and enhance radiosensitivity

Q5. Which immune checkpoint inhibitor is FDA‑approved for recurrent/metastatic head and neck squamous cell carcinoma after platinum failure?

• Ipilimumab
• Pembrolizumab
• Nivolumab
• Atezolizumab

Correct Answer: Nivolumab

Q6. For carboplatin dosing in head and neck cancer, which formula is routinely used to calculate dose based on desired AUC?

• Cockcroft-Gault clearance × target concentration
• Calvert formula using estimated glomerular filtration rate and target AUC
• Body surface area (BSA) only (mg/m2)
• Fixed flat dosing regardless of renal function

Correct Answer: Calvert formula using estimated glomerular filtration rate and target AUC

Q7. Which adverse effect is most specifically associated with EGFR inhibitors like cetuximab and often correlates with treatment response?

• Nephrotoxicity
• Acneiform papulopustular rash
• Cardiotoxicity with reduced ejection fraction
• Severe peripheral neuropathy

Correct Answer: Acneiform papulopustular rash

Q8. HPV (p16) positive oropharyngeal cancers are characterized pharmacotherapeutically by which clinical implication?

• Worse prognosis and reduced chemotherapy sensitivity
• Better prognosis and ongoing trials for therapy de‑escalation in selected patients
• Mandatory use of EGFR inhibitors instead of cisplatin
• No difference in treatment approach compared with HPV-negative tumors

Correct Answer: Better prognosis and ongoing trials for therapy de‑escalation in selected patients

Q9. Which oral prodrug is metabolized to 5‑fluorouracil and sometimes used in head and neck cancer?

• Capecitabine
• Methotrexate
• Temozolomide
• Cyclophosphamide

Correct Answer: Capecitabine

Q10. The major dose-limiting toxicity of high‑dose cisplatin in head and neck treatment is:

• Cardiac arrhythmias
• Nephrotoxicity and ototoxicity
• Severe alopecia only
• Pulmonary fibrosis

Correct Answer: Nephrotoxicity and ototoxicity

Q11. Which strategy is most important to reduce cisplatin-induced nephrotoxicity in head and neck cancer patients?

• Administer vancomycin concurrently to protect kidneys
• Pre- and post-hydration with saline and magnesium supplementation when indicated
• Give furosemide to induce diuresis without hydration
• Use high-dose vitamin C infusions

Correct Answer: Pre- and post-hydration with saline and magnesium supplementation when indicated

Q12. Which radiotherapy technique is preferred to spare salivary glands and reduce xerostomia in head and neck cancer patients?

• Two-dimensional conventional radiotherapy
• Intensity-modulated radiotherapy (IMRT)
• Whole-neck brachytherapy for all patients
• Stereotactic body radiotherapy (SBRT) for primary bulky disease

Correct Answer: Intensity-modulated radiotherapy (IMRT)

Q13. In the context of systemic therapy for head and neck cancer, which statement about pembrolizumab is correct?

• Pembrolizumab is a CTLA‑4 inhibitor used as adjuvant therapy
• Pembrolizumab targets PD-1 and can be used first‑line for PD‑L1 positive recurrent/metastatic disease
• Pembrolizumab directly inhibits EGFR signaling
• Pembrolizumab is used primarily to reduce mucositis during chemoradiation

Correct Answer: Pembrolizumab targets PD-1 and can be used first‑line for PD‑L1 positive recurrent/metastatic disease

Q14. Which supportive agent is FDA‑approved to reduce the risk of cumulative cisplatin‑induced nephrotoxicity when used prophylactically in head and neck cancer?

• Amifostine
• Erythropoietin
• Leucovorin
• Mesna

Correct Answer: Amifostine

Q15. Which adverse event profile is most characteristic of PD‑1 inhibitors like nivolumab and pembrolizumab in head and neck cancer patients?

• Immediate anaphylaxis in most patients
• Immune-related adverse events such as colitis, pneumonitis, hepatitis, and endocrinopathies
• Severe nephrotoxicity dose‑dependently
• Profound, prolonged myelosuppression

Correct Answer: Immune-related adverse events such as colitis, pneumonitis, hepatitis, and endocrinopathies

Q16. Which chemotherapy agent is most commonly substituted for cisplatin in patients with contraindications to cisplatin during concurrent chemoradiation?

• Doxorubicin
• Carboplatin
• Busulfan
• Bleomycin

Correct Answer: Carboplatin

Q17. In managing chemoradiation-induced oral mucositis in head and neck cancer, which pharmacologic approach is evidence‑based to reduce severity?

• Routine prophylactic systemic antibiotics
• Topical benzydamine mouthwash and comprehensive oral care; palifermin for selected hematologic settings
• High-dose systemic steroids throughout radiotherapy
• Daily intravenous magnesium sulfate

Correct Answer: Topical benzydamine mouthwash and comprehensive oral care; palifermin for selected hematologic settings

Q18. Which parameter is most relevant when deciding dose adjustment of chemotherapy for older head and neck cancer patients?

• Chronological age alone
• Comprehensive geriatric assessment including renal function, performance status, comorbidities, and functional reserve
• Height only
• Hair color

Correct Answer: Comprehensive geriatric assessment including renal function, performance status, comorbidities, and functional reserve

Q19. Which clinical trial finding influenced current practice regarding cetuximab plus radiotherapy versus cisplatin plus radiotherapy for locally advanced HPV‑positive oropharyngeal cancer?

• Cetuximab plus radiotherapy showed superior overall survival compared with cisplatin
• Cetuximab plus radiotherapy resulted in worse outcomes than cisplatin plus radiotherapy, discouraging substitution of cetuximab for cisplatin
• Both regimens were identical in efficacy and toxicity
• Cisplatin was found to be contraindicated in HPV‑positive disease

Correct Answer: Cetuximab plus radiotherapy resulted in worse outcomes than cisplatin plus radiotherapy, discouraging substitution of cetuximab for cisplatin

Q20. For a pharmacist counseling on antiemetic prophylaxis for highly emetogenic cisplatin regimens in head and neck cancer, the guideline‑recommended multi‑drug regimen typically includes:

• Only a single agent dopamine antagonist
• A 5‑HT3 antagonist, an NK1 receptor antagonist, and a corticosteroid (with olanzapine when appropriate)
• Routine antibiotic prophylaxis and proton pump inhibitor only
• High‑dose aspirin and acetaminophen

Correct Answer: A 5‑HT3 antagonist, an NK1 receptor antagonist, and a corticosteroid (with olanzapine when appropriate)

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