Oncology principles: cancer chemotherapy basics MCQs With Answer

Introduction: Oncology principles: cancer chemotherapy basics MCQs With Answer offers M.Pharm students a focused review of essential chemotherapy concepts encountered in Pharmacotherapeutics II. This collection emphasizes mechanisms of action, cell cycle specificity, pharmacokinetics, resistance, toxicity profiles and clinical use principles such as combination therapy design, dosing strategies and supportive care. Each question probes deeper than rote facts—asking you to apply pharmacologic reasoning to therapeutic choices, adverse effect management and laboratory monitoring. Answers are provided to reinforce learning and self-assessment. Use this quiz to consolidate understanding before exams and to develop the clinical pharmacology judgment necessary for oncology practice and research.

Q1. Which principle best explains why combination chemotherapy uses drugs with different mechanisms of action?

• To increase the chance of overlapping toxicities and ensure tumor kill
• To attack cancer cells through multiple molecular targets and reduce emergence of drug resistance
• To simplify dosing schedules for patient convenience
• To minimize the total drug dose administered

Correct Answer: To attack cancer cells through multiple molecular targets and reduce emergence of drug resistance

Q2. The log-kill hypothesis in chemotherapy refers to which concept?

• Cancer cell death occurs linearly with increasing dose
• A fixed percentage of tumor cells are killed with each chemotherapy cycle
• Cancer cells multiply logarithmically in response to chemotherapy
• Cure requires complete surgical resection rather than drug therapy

Correct Answer: A fixed percentage of tumor cells are killed with each chemotherapy cycle

Q3. Which class of cytotoxic agents is primarily cell cycle–nonspecific and causes DNA crosslinking?

• Antimetabolites (e.g., 5-FU)
• Topoisomerase inhibitors (e.g., etoposide)
• Alkylating agents (e.g., cyclophosphamide)
• Microtubule inhibitors (e.g., paclitaxel)

Correct Answer: Alkylating agents (e.g., cyclophosphamide)

Q4. Which mechanism is a common cause of multidrug resistance (MDR) in tumor cells?

• Overexpression of dihydrofolate reductase
• Mutation in tubulin binding sites only
• Upregulation of P-glycoprotein efflux pumps
• Increased intracellular drug activation

Correct Answer: Upregulation of P-glycoprotein efflux pumps

Q5. Which adverse effect is the dose-limiting toxicity for most classic cytotoxic agents and often determines dosing intervals?

• Cardiotoxicity
• Myelosuppression (bone marrow suppression)
• Neurotoxicity
• Hepatotoxicity

Correct Answer: Myelosuppression (bone marrow suppression)

Q6. A chemotherapy agent that is S-phase specific is most effective when administered in which way?

• Single high bolus dose only once
• Continuous infusion or repeated doses to catch cells entering S-phase
• Topical application
• Administered only after radiotherapy

Correct Answer: Continuous infusion or repeated doses to catch cells entering S-phase

Q7. Which antimetabolite is inactivated by dihydropyrimidine dehydrogenase (DPD) and causes severe toxicity in patients with DPD deficiency?

• Methotrexate
• 5-Fluorouracil (5-FU)
• Cytarabine
• Mercaptopurine (6-MP)

Correct Answer: 5-Fluorouracil (5-FU)

Q8. Which growth factor is commonly used prophylactically to reduce the duration and severity of chemotherapy-induced neutropenia?

• Erythropoietin (EPO)
• Interleukin-2 (IL-2)
• Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)
• Thrombopoietin receptor agonists

Correct Answer: Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)

Q9. Tumor lysis syndrome results from rapid tumor breakdown and is characterized by which laboratory abnormalities?

• Hypokalemia and hypouricemia
• Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia
• Hypoglycemia and hyponatremia
• Isolated elevation of liver enzymes

Correct Answer: Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia

Q10. Which statement best distinguishes targeted therapy from traditional cytotoxic chemotherapy?

• Targeted therapy always has no toxicity to normal tissues
• Targeted therapy interferes with specific molecular pathways driving cancer growth
• Targeted therapy is always administered orally
• Targeted therapy is only effective for hematologic malignancies

Correct Answer: Targeted therapy interferes with specific molecular pathways driving cancer growth

Q11. Which enzyme polymorphism is clinically important for modifying dosing of mercaptopurine (6-MP)?

• Dihydropyrimidine dehydrogenase (DPD)
• N-acetyltransferase 2 (NAT2)
• Thiopurine S-methyltransferase (TPMT)
• CYP2D6

Correct Answer: Thiopurine S-methyltransferase (TPMT)

Q12. Which cytotoxic drug class acts by inhibiting microtubule disassembly leading to mitotic arrest and peripheral neuropathy?

• Vinca alkaloids (e.g., vincristine)
• Taxanes (e.g., paclitaxel)
• Alkylating agents
• Antimetabolites

Correct Answer: Taxanes (e.g., paclitaxel)

Q13. Which one of the following is a major cardiotoxic agent requiring lifetime cumulative dose monitoring?

• Cisplatin
• Doxorubicin (an anthracycline)
• Bleomycin
• Fludarabine

Correct Answer: Doxorubicin (an anthracycline)

Q14. Why is body surface area (BSA) commonly used to dose many chemotherapeutic drugs?

• BSA perfectly predicts drug clearance for all agents
• BSA reduces interpatient variability in drug exposure compared with fixed dosing for many cytotoxics
• BSA is easier to measure than weight
• BSA dosing eliminates need for renal function adjustment

Correct Answer: BSA reduces interpatient variability in drug exposure compared with fixed dosing for many cytotoxics

Q15. Which supportive medication is most appropriate to prevent acute emesis induced by highly emetogenic chemotherapy?

• Proton pump inhibitor alone
• 5-HT3 receptor antagonist (e.g., ondansetron) often combined with NK1 antagonist and dexamethasone
• Antihistamine alone
• Loperamide

Correct Answer: 5-HT3 receptor antagonist (e.g., ondansetron) often combined with NK1 antagonist and dexamethasone

Q16. Which chemotherapeutic agent class is most associated with pulmonary fibrosis as a serious toxicity?

• Bleomycin
• Vinca alkaloids
• Alkylating agents except bleomycin
• Antimetabolites

Correct Answer: Bleomycin

Q17. A prodrug activated in the liver into its cytotoxic metabolite (used in various solid tumors) is:

• Cisplatin
• Paclitaxel
• Cyclophosphamide
• Vinblastine

Correct Answer: Cyclophosphamide

Q18. Which laboratory test is most important to monitor before each cycle when giving methotrexate at high doses?

• Serum creatinine and urine output because renal clearance affects methotrexate elimination
• Fasting blood glucose only
• Liver function tests only; renal function is irrelevant
• Serum potassium and magnesium only

Correct Answer: Serum creatinine and urine output because renal clearance affects methotrexate elimination

Q19. The vesicant property of some chemotherapy drugs means what important clinical risk?

• They commonly cause severe systemic hypotension
• If they extravasate into tissues, they can cause severe local tissue necrosis and require specific management
• They are ineffective unless given orally
• They only affect the vascular endothelium without systemic toxicity

Correct Answer: If they extravasate into tissues, they can cause severe local tissue necrosis and require specific management

Q20. Which of the following best describes the rationale for dose-dense chemotherapy schedules?

• To allow tumors to regrow faster between cycles
• To increase the frequency of cycles and reduce time for tumor cell repopulation, often with growth factor support
• To minimize myelosuppression without additional supportive care
• To provide a single high peak dose rather than multiple treatments

Correct Answer: To increase the frequency of cycles and reduce time for tumor cell repopulation, often with growth factor support

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