Lung cancer pharmacotherapy MCQs With Answer

Lung cancer pharmacotherapy MCQs With Answer

Introduction: This quiz collection is designed specifically for M.Pharm students studying Pharmacotherapeutics II (MPP 202T) to strengthen clinical and mechanistic understanding of lung cancer drug therapy. It covers chemotherapy regimens, targeted agents, immune checkpoint inhibitors, biomarkers, resistance mechanisms, adverse-effect management, and supportive care considerations. Questions emphasize pharmacology, molecular targets, drug interactions, dosing rationale, and monitoring parameters that are essential for pharmacists involved in oncology. Each MCQ includes plausible distractors and a clear correct answer to help you prepare for exams and clinical decision-making. Use these to test recall, apply concepts, and identify areas for focused study.

Q1. Which agent is currently preferred as first-line therapy for advanced non-small cell lung cancer (NSCLC) with common sensitizing EGFR mutations (exon 19 deletion or L858R)?

• Gefitinib
• Pembrolizumab
• Carboplatin plus pemetrexed
• Osimertinib

Correct Answer: Osimertinib

Q2. What is the primary mechanism of action of pembrolizumab in lung cancer therapy?

• Monoclonal antibody against VEGF-A
• PD-1 receptor blockade on T cells
• Small-molecule EGFR tyrosine kinase inhibition
• CTLA-4 receptor blockade

Correct Answer: PD-1 receptor blockade on T cells

Q3. What is the standard platinum-based doublet chemotherapy regimen commonly used for first-line treatment of small cell lung cancer (SCLC)?

• Pemetrexed plus carboplatin
• Paclitaxel plus carboplatin
• Cisplatin plus etoposide
• Gemcitabine plus carboplatin

Correct Answer: Cisplatin plus etoposide

Q4. For first-line pembrolizumab monotherapy in metastatic NSCLC, what PD-L1 tumor proportion score (TPS) threshold is generally used to select patients?

• PD-L1 TPS ≥1%
• PD-L1 TPS ≥10%
• PD-L1 TPS ≥50%
• PD-L1 TPS ≥75%

Correct Answer: PD-L1 TPS ≥50%

Q5. Which mutation is the most common mechanism of acquired resistance to first-generation EGFR tyrosine kinase inhibitors?

• T790M point mutation in EGFR
• L858R activating mutation in EGFR
• Exon 19 deletion in EGFR
• ALK gene rearrangement

Correct Answer: T790M point mutation in EGFR

Q6. Which ALK inhibitor is preferred first-line for ALK-rearranged NSCLC due to superior CNS penetration and improved outcomes compared with crizotinib?

• Crizotinib
• Alectinib
• Erlotinib
• Osimertinib

Correct Answer: Alectinib

Q7. Which therapeutic agent is contraindicated or used with extreme caution in patients with squamous-cell NSCLC because of a high risk of life-threatening hemoptysis?

• Bevacizumab
• Pembrolizumab
• Cisplatin
• Osimertinib

Correct Answer: Bevacizumab

Q8. What is the initial management for moderate (grade 2) immune-related colitis from checkpoint inhibitor therapy?

• Continue checkpoint inhibitor and observe
• Administer broad-spectrum antibiotics immediately
• Hold checkpoint inhibitor and start systemic corticosteroids
• Give high-dose infliximab as first-line

Correct Answer: Hold checkpoint inhibitor and start systemic corticosteroids

Q9. Which tumor marker is commonly used as a biochemical indicator and for monitoring in small cell lung cancer?

• Carcinoembryonic antigen (CEA)
• Prostate-specific antigen (PSA)
• Neuron-specific enolase (NSE)
• CA-125

Correct Answer: Neuron-specific enolase (NSE)

Q10. What is the molecular mechanism of action of bevacizumab?

• Small-molecule VEGFR tyrosine kinase inhibitor
• Monoclonal antibody that binds circulating VEGF-A ligand
• Anti-PD-L1 monoclonal antibody
• Inhibitor of angiopoietin signaling

Correct Answer: Monoclonal antibody that binds circulating VEGF-A ligand

Q11. Why are folic acid and vitamin B12 supplementation recommended with pemetrexed therapy?

• To enhance antitumor efficacy by increasing DNA damage
• To prevent renal toxicity caused by pemetrexed
• To reduce hematologic and gastrointestinal toxicities of pemetrexed
• To prevent neuropathy associated with pemetrexed

Correct Answer: To reduce hematologic and gastrointestinal toxicities of pemetrexed

Q12. Osimertinib has clinical advantages in EGFR-mutated NSCLC primarily because it:

• Targets ALK rearrangements effectively
• Is active against EGFR T790M resistance mutations and penetrates the CNS
• Is an anti-PD-1 antibody with fewer immune-related adverse events
• Inhibits VEGF and reduces tumor angiogenesis

Correct Answer: Is active against EGFR T790M resistance mutations and penetrates the CNS

Q13. Small cell lung cancer is commonly associated with which paraneoplastic endocrine syndrome?

• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Hypercalcemia due to PTHrP secretion
• Hypoglycemia due to insulin production
• Primary hyperaldosteronism

Correct Answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Q14. Which statement best reflects use of immune checkpoint inhibitors in patients with a history of solid-organ transplantation?

• They are safe and have no impact on graft function
• They are a relative contraindication because of high risk of graft rejection
• They are absolutely contraindicated in all transplant recipients
• They should be used only at double the standard dose

Correct Answer: They are a relative contraindication because of high risk of graft rejection

Q15. Crizotinib is best described as an inhibitor of which primary molecular target in lung cancer?

• EGFR tyrosine kinase
• ALK and ROS1 tyrosine kinases
• BRAF V600E kinase
• PD-1 immune checkpoint

Correct Answer: ALK and ROS1 tyrosine kinases

Q16. Which targeted therapy combination is indicated for NSCLC harboring BRAF V600E mutations?

• Osimertinib plus bevacizumab
• Dabrafenib plus trametinib
• Crizotinib monotherapy
• Pembrolizumab plus platinum doublet

Correct Answer: Dabrafenib plus trametinib

Q17. What laboratory technique is most commonly used to determine PD-L1 expression on tumor cells to guide immunotherapy decisions?

• Polymerase chain reaction (PCR)
• Immunohistochemistry (IHC)
• Fluorescence in situ hybridization (FISH)
• ELISA for circulating PD-L1

Correct Answer: Immunohistochemistry (IHC)

Q18. What is the recommended initial management for a grade 2 dermatologic rash caused by EGFR tyrosine kinase inhibitors?

• Permanently discontinue the EGFR inhibitor
• Immediate systemic antibiotics without other measures
• Topical corticosteroids/emollients and consider temporary interruption or dose reduction
• Switch to immune checkpoint inhibitor therapy

Correct Answer: Topical corticosteroids/emollients and consider temporary interruption or dose reduction

Q19. Which adverse effect is classically dose-limiting for paclitaxel therapy in lung cancer patients?

• Nephrotoxicity
• Cardiotoxicity
• Peripheral sensory neuropathy
• Severe mucositis

Correct Answer: Peripheral sensory neuropathy

Q20. At what estimated risk threshold of febrile neutropenia from a chemotherapy regimen is primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) generally recommended?

• When risk is >5%
• When risk is >10%
• When risk is >20%
• When risk is >50%

Correct Answer: When risk is >20%

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