Lippincott Chapter 46: Anticancer Drugs

Question 1

46.1 A patient is about to undergo three cycles of chemo-
therapy prior to surgery for bladder cancer. Which of the
following best describes chemotherapy in this setting?
A. Adjuvant.
B. Neoadjuvant.
C. Palliative.
D. Maintenance.

Answer 1

Correct answer = B. Since the chemotherapy is being
given before the surgery, it is considered neoadjuvant.
Chemotherapy is indicated when neoplasms are dis-
seminated and are not amenable to surgery (palliative).
Chemotherapy is also used as a supplemental treatment
to attack micrometastases following surgery and radiation
treatment, in which case it is called adjuvant chemotherapy.
Chemotherapy given prior to the surgical procedure in an
attempt to shrink the cancer is referred to as neoadjuvant
chemotherapy, and chemotherapy given in lower doses to
assist in prolonging a remission is known as maintenance
chemotherapy.

Question 2

46.2 A 45-year-old male patient is being treated with ABVD
chemotherapy for Hodgkin lymphoma. He presents for
cycle 4 of a planned 6 cycles with a new-onset cough.
He states it started a week ago and he also feels like
he has a little trouble catching his breath. Which drug
in the ABVD regimen is the most likely cause of his
pulmonary toxicity?
A. Doxorubicin (Adriamycin).
B. Bleomycin.
C. Vinblastine.
D. Dacarbazine.

Answer 2

Correct answer = B. Pulmonary toxicity is the most seri-
ous adverse effect of bleomycin, progressing from rales,
cough, and infiltrate to potentially fatal fibrosis. The pulmo-
nary fibrosis that is caused by bleomycin is often referred
as “bleomycin lung.”

Question 3

46.3 FL is a 64-year-old male about to undergo therapy
for rhabdomyosarcoma. His chemotherapy includes
ifosfamide. Which of the following is most appropriate to
include in chemotherapy orders for this patient?
A. IV hydration, mesna, and frequent urinalyses.
B. Leucovorin and frequent urinalyses.
C. Allopurinol and frequent urinalyses.
D. IV hydration, prophylactic antibiotics, and frequent
urinalyses.

Answer 3

Correct answer = A. A unique toxicity of ifosfamide is hemor-
rhagic cystitis. This bladder toxicity has been attributed to
toxic metabolites of ifosfamide. Adequate hydration as well
as IV injection of mesna (sodium 2-mercaptoethane sulfo-
nate), which neutralizes the toxic metabolites, can minimize
this problem. Frequent urinalyses to monitor for red blood
cells should be ordered. Leucovorin is used with methotrex-
ate or 5-FU (not ifosfamide). Allopurinol has a drug inter-
action with ifosfamide and is not an agent that prevents
hemorrhagic cystitis. Prophylactic antibiotics are not needed.

Question 4

46.4 The appearance of a facial rash with cetuximab is
associated with which of the following?
A. A negative response to therapy.
B. A positive response to therapy.
C. A drug allergy.
D. An infusion reaction.

Answer 4

Correct answer = B. Patients undergoing therapy with an
EGFR inhibitor such as cetuximab often develop an acne-
like rash on the face, chest, upper back, and arms. The
appearance of such a rash has been correlated with an
increased response as compared to patients who do not
experience a rash during therapy.