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Andhika Rachman,1,2 Zaenal Hakiki Fiantoro,3 Noorwati Sutandyo,4 Dimas Priantono,1 Pradana Zaky Romadhon,5 Reganedgary Jonlean6 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Siloam MRCCC Semanggi Hospital, Jakarta, Indonesia; 3Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 4Dharmais National Cancer Referral Hospital, Jakarta, Indonesia; 5Division of Hematology and Medical Oncology, Department of Internal Medicine, Airlangga University, Surabaya, Indonesia; 6Tzu Chi Hospital, Jakarta, IndonesiaCorrespondence: Andhika Rachman, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Pangeran Diponegoro No. 71, Jakarta, 10430, Indonesia, Tel +62 813 9862 0570, Email andhika_rachman@office.ui.ac.id; andhikarachman@gmail.comIntroduction: Metastatic breast cancer was associated with high morbidity and mortality. Insulin resistance was hypothesized to be related to the incidence of advanced breast cancer. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Triglyceride/Glucose Index (TyG Index) are two metrics used to measure the degree of insulin resistance. This study aims to assess the relationship between the incidence of metastatic breast cancer and insulin resistance as reflected by both metrics.Material and Methods: This study is a cross-sectional study involving 150 primary invasive breast cancer patients recruited from two hospitals of different sectors from August 2019 to April 2020. Patients with double cancer and autoimmune disorder were excluded from this study. Data obtained from the patients include age, body mass index (BMI), type 2 diabetes mellitus (T2DM) status and treatment, and low-density lipoprotein (LDL) cholesterol. The electronic medical records (EMR) was consulted to find histopathology examination result, cancer staging, and any missing data. The association between HOMA-IR and TyG with metastatic incidence was analyzed using either the Mann–Whitney test (for non-normally distributed data) or the independent-sample t-test (for normally distributed data).Results: The mean of the TyG index is 8.60, and the median of HOMA-IR is 1.22. We found no significant correlation between both variables and the incidence of metastases.Conclusion: Insulin resistance was not associated with metastatic breast cancer.Keywords: HOMA-IR, TyG index, breast cancer, metastases

Noorwati Sutandyo,1 Della Manik Worowerdi Cintakaweni,2 Lyana Setiawan,3 Ririn Hariani,2 Nani Utami2 1Department of Hematology and Medical Oncology, Dharmais National Cancer Center Hospital, Jakarta, Indonesia; 2Department of Clinical Nutrition, Dharmais National Cancer Center Hospital, Jakarta, Indonesia; 3Department of Integrated Laboratory, Dharmais National Cancer Center Hospital, Jakarta, IndonesiaCorrespondence: Noorwati Sutandyo, Email noorwatis3@yahoo.comIntroduction: Cachexia is prevalent in cancer and is associated with poorer prognosis. We aimed to investigate the association of interleukin-6 (IL-6) and vitamin D levels with cachexia in cancer patients. We also assessed the relationship between body composition profile and cachexia, IL-6, and vitamin D levels.Methods: A cross-sectional study was conducted at Dharmais National Cancer Hospital. The study included patients with newly diagnosed biopsy-proven nasopharyngeal cancer, lung cancer, breast cancer, cervical cancer, or non-Hodgkin lymphoma. Blood samples, anthropometrics, and body composition were measured.Results: A total of 150 cancer patients were included in the study, with a median age of 52 years, and 64% (n = 96) are female. The prevalence of cachexia was 57%. Cancer patients with cachexia had higher IL-6 levels (P = 0.025). No association between cachexia and vitamin D levels was found (P = 0.787). Patients with cachexia had lower body composition components than those without cachexia (P < 0.05). Vitamin D levels were positively correlated with muscle mass, visceral fat, and handgrip strength (P < 0.05), while no association between IL-6 and body composition was found.Conclusion: Cancer-associated cachexia is associated with a higher level of IL-6, lower BMI, lower fat mass index, and lower visceral fat. Vitamin D levels, but not IL-6, are correlated with muscle mass, muscle strength, and visceral fat in cancer patients.Keywords: interleukin-6, vitamin D, cachexia, handgrip strength, cancer, nutrition

Noorwati Sutandyo,1,2 Arif Riswahyudi Hanafi,3 Achmad Mulawarman Jayusman,3 Sri Agustini Kurniawati,1 Muhamad Alfin Hanif3 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital, Jakarta, Indonesia; 2Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 3Department of Pulmonology, Dharmais National Cancer Hospital, Jakarta, IndonesiaCorrespondence: Noorwati Sutandyo, Email noorwatis3@yahoo.comBackground and Aim: Most patients with non-small cell lung cancer (NSCLC) are diagnosed in advanced-stage disease and therefore have poor overall survival. It remains unclear whether nutritional status affects response rate and overall survival in NSCLC patients. This study aimed to evaluate the association of nutritional status with treatment response and overall survival in patients with advanced stage of NSCLC.Methods: Patients aged ≥ 18 years with stage II–IV NSCLC (January–June 2018) in a national cancer center in Indonesia were enrolled in this study. The patients were followed up for 2 years since NSCLC diagnosis was established. Clinical data including age, sex, histology of cancer, disease stage, cachexia, and weight status before chemotherapy were reviewed and analyzed. Logistic regression and Cox regression analyses were performed.Results: A total of 174 patients (71% males, mean age = 58± 9.4 years) was included. Complete response was found in < 1% patients, partial response 41%, stable disease 33%, and progressive disease 25%. Median survival was 12 months (95% CI: 11– 13 months). Mortality rate was 5.7 per 100 person-months. Poor survival was associated with being males (HR: 1.77, 95% CI: 1.15– 2.72, P = 0.009), and overweight or obesity (HR 1.67, 95% CI: 1.04– 2.69, P = 0.034). These associations were independent of sex, age, staging, histopathology, performance status and D-dimer level at baseline. Cachexia and BMI at baseline were not associated with treatment response.Conclusion: Males and having overweight or obesity are independently associated with lower survival in patients with advanced stage of NSCLC undergoing platinum-based chemotherapy.Keywords: body mass index, nutritional status, lung cancer

Tubagus Djumhana Atmakusuma,1 Intan Russiana Nasution,2 Noorwati Sutandyo3 1Division of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 2Division of Hematology-Medical Oncology, Department of Internal Medicine, Gatot Soebroto Army Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; 3Division of Hematology-Medical Oncology, Department of Internal Medicine, Dharmais National Cancer Hospital Jakarta/Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Tubagus Djumhana AtmakusumaDivision of Hematology-Medical Oncology, Department of Internal Medicine, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, DKI, Jakarta, IndonesiaEmail hom_fkui@yahoo.comBackground: Iron overload is a major problem in both transfusion-dependent (TDT) and non-transfusion-dependent thalassemia (NTDT). It has been known to increase oxidative stress. Meanwhile, blood transfusion as main therapy for thalassemia increases iron overload. One of the markers of oxidative stress is malondialdehyde (MDA). This study aims to provide data on MDA levels in adult thalassemia patients, and to compare the levels before and after transfusion in patients with TDT and NTDT.Methods: This is a cross-sectional, pre-post study in adult patients with thalassemia major and intermedia that received blood transfusion with or without iron-chelating agents in Cipto Mangunkusumo Hospital. Blood samples were taken immediately before the transfusion and one day after. Serum ferritin (SF) assays were conducted by electrochemiluminescence immunoassay method, while transferrin saturation (TS) was calculated by dividing serum iron by the binding capacity. Subsequently, plasma MDA levels assays were performed using the Wills method, and data analysis was conducted using the t-test/Mann–Whitney and Pearson/Spearman correlation test, depending on the data distribution.Results: The 63 respondents recruited consist of 51 TDT and 12 NTDT patients, and their median plasma MDA level before and after transfusion was 0.49 μmol/L and 0.45 μmol/L, respectively. Before transfusion, there was no correlation between SF and MDA, and TS and MDA levels. After the transfusion, there was no correlation between, SF and MDA, or TS and MDA levels.Conclusion: There is no significant difference in MDA levels before and after transfusion. Although blood transfusion increases the iron load in thalassemia patients, there was no increase in median MDA level after transfusion. Meanwhile, there was no correlation between markers of iron overload and MDA level in thalassemia patients both before and after transfusion.Keywords: iron overload, malondialdehyde, oxidative stress, non-transfusion dependent thalassemia, transfusion-dependent thalassemia

OBJECTIVE: This study aimed to compare the mortality rate between advanced-stage non-small cell lung cancer patients (NSCLC) with and without COVID-19. This study also explores the possible laboratory characteristics used for prognostication in patients with NSCLC and COVID-19. Additionally, this study evaluated potential differences in laboratory values between the case and control groups. PATIENTS AND METHODS: This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia, enrolling patients with NSCLC undergoing chemotherapy or targeted therapy between May 2020 and January 2021. All patients with NSCLC and COVID-19 in these periods were enrolled into the case group. The control group was agematched NSCLC patients without COVID-19 that was derived from the NSCLC cohort through randomization. RESULTS: There were 342 patients with NSCLC between May 2020 and January 2021. Twenty-seven (7.9%) of the patients were infected by COVID-19. To facilitate comparison, thirty-five age-matched controls with NSCLC were selected from the cohort. The mortality rate in patients with COVID-19 was 46.2%. Eleven patients (40.7%) had severe COVID-19, of which none survived. NLR >8.35 has a sensitivity of 83.3%, specificity of 92.9%, LR+ of 12, and LR- of 0.18. The AUC was 0.946 (95% CI 0.867-1.000), p<0.001. PLR >29.14 has a sensitivity of 75.0%, specificity of 71.4%, LR+ 2.62, LR- 0.35, and AUC 0.851 (95% CI 0.706-0.996), p=0.002. Both NLR and PLR were associated with shorter time-to-mortality in the unadjusted and adjusted model CONCLUSIONS: NLR and PLR are independent predictors of mortality in COVID-19 patients with NSCLC. [ABSTRACT FROM AUTHOR]

Breast cancer is commonly acknowledged as the primary type of cancer on a global scale, exerting a substantial influence on death rates, particularly in developing countries. The aforementioned discovery provides evidence in favor of the concept that genetic factors may contribute to the onset of breast cancer. This paper presents the unprocessed idat data containing single nucleotide polymorphisms (SNPs) acquired from breast cancer patients and a control group comprising of healthy women. The DNA was obtained from stored blood samples that were collected from a total of 48 female patients diagnosed with breast cancer at Cipto Mangunkusumo National Hospital Jakarta and Dharmais National Cancer Center Hospital Jakarta. Additionally, 24 healthy women were included as control subjects. Subsequently, the DNA samples were subjected to hybridization onto Infinium Asian Screening Array (ASA)'s beadchips. The chip was then subjected to fluorescence intensity measurements using an iScan machine manufactured by Illumina. The data output is produced in the form of a .idat file for each sample. Subsequently, further quality control measures and population stratification analysis were conducted using PLINK (v1.9). After the conclusion of the quality control procedure, 72 individuals and a dataset consisting of 424,285 genetic variants were selected for further analysis. The idat raw data files have been added to the Gene Expression Omnibus (GEO) with accession number: GSE245794 (https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE245794) ., (© 2025 The Author(s).)

Cancer is still the leading cause of death worldwide. Despite advances in diagnosis, management with the rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) chemotherapy regimen, and careful clinical and radiologic evaluation, diffuse large B-cell lymphoma (DLBCL) still carries high recurrence in clinical practice. This case series aims to assess the potential of circulating free RNA as a biomarker for evaluating therapeutic responses in DLBCL. This case series was conducted at Dharmais National Cancer Center Hospital in Jakarta in 2020. The subjects were 13 DLBCL patients who came for treatment to our hospital in 2020. Sampling was carried out by taking peripheral blood, which was taken 7-14 days after the patient underwent the 3rd and 6th cycles of chemotherapy or before and 7-14 days following the 3rd cycle of chemotherapy. Circulating free RNA (cfRNA) was extracted and assessed. The quantity of cfRNA was subsequently examined twice as matching samples from each patient, with the following results - (1) no mutations detected; (2) mutation detected solely in the second examination; (3) mutation only detected in the first examination; and (4) changes in gene mutations and mutation types. Statistic tabulation neither showed an association between recurrency and clinical variables nor detected cfRNA from the matching samples. This case series underscores the challenges in utilizing cfRNA as a biomarker for therapeutic evaluation in DLBCL due to heterogeneity and increased mutations in post chemotherapy conditions. Further research with larger sample sizes is needed to emphasize the role of cfRNA in DLBCL disease monitoring.

Objective: Breast cancer is the leading cause of cancer incidence and mortality among Indonesian women. A comprehensive investigation is required to enhance the early detection of this disease. Mitochondrial DNA copy number (mtDNA-CN) and relative telomere length (RTL) have been proposed as potential biomarkers for several cancer risks, as they are linked through oxidative stress mechanisms. We conducted a case-control study to examine peripheral blood mtDNA-CN and RTL patterns in Indonesian breast cancer patients (n = 175) and healthy individuals (n = 181). The relative ratios of mtDNA-CN and RTL were determined using quantitative real-time PCR (qPCR)., Results: Median values of mtDNA-CN and RTL were 1.62 and 0.70 in healthy subjects and 1.79 and 0.73 in breast cancer patients, respectively. We found a positive association between peripheral blood mtDNA-CN and RTL (p < 0.001). In under 48 years old breast cancer patients, higher peripheral blood mtDNA-CN (mtDNA-CN ≥ 1.73 (median), p = 0.009) and RTL (continuous variable, p = 0.010) were observed, compared to the corresponding healthy subjects. We also found a significantly higher 'High-High' pattern of mtDNA-CN and RTL in breast cancer patients under 48 years old (p = 0.011). Our findings suggest that peripheral blood mtDNA-CN and RTL could serve as additional minimally invasive biomarkers for breast cancer risk evaluation., (© 2024. The Author(s).)

Background: Cytogenetics is a fundamental examination in the course and management of myelodysplastic syndrome (MDS) since it is widely used as a diagnostic and prognostic indicator for the disease. Some cytogenetic profiles are associated with a higher risk of acute myeloid leukemia (AML) transformation. This is the first study to evaluate the cytogenetic profile of Indonesian patients with MDS., Methods: This prospective cohort study was conducted at the Cancer Center and several other referral hospitals. Patients with primary MDS aged >18 years were included in the study. Clinical examination, peripheral blood smear, and bone marrow aspiration were performed, followed by cytogenetic examination. The results were further categorized into revised international prognostic scoring system (IPSS-R) scores, and cytogenetic profiles were descriptively presented. Patients were followed up for one year to evaluate AML transformation., Results: A total of 28 MDS patients, aged 66±12 years, were included in this study. The majority of the patients were male (n=17;60.7%), aged 65 years or above (n=19;67.9%), diagnosed with MDS-MLD (n=14;50%), and had an intermediate cytogenetic group (n=4;14.3%). The IPSS-R score was high in 6 (21.4%) patients and very high risk in 3 (10.7%) patients. During one-year follow-up, AML transformation occurred in 3 (10.7%) patients, and 10 (35.7%) patients ceased. Monosomy 7 was observed in 6 (21.4%) patients but in one metaphase each. Deletion of chromosome 5 (del(5)(q31)), del (16)(q21.1), and del (16)(q11.2) were found in a male patient with MDS-EB1., Conclusions: Monosomy 7 and deletion of chromosome 5 have been identified in Indonesian patients with MDS. MDS-EB has the highest risk of AML transformation., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Sutandyo N et al.)

Objective: This study aimed to investigate the associations of CD8+, PARP, and EGFR expressions with two-year survival in patients with triple-negative breast cancer (TNBC)., Methods: A retrospective cohort study was conducted in a national cancer center. All patients aged 18 years diagnosed with TNBC (2013-2017) were included and followed for 24 months or until the patients were deceased. Kaplan-Meier survival function and Cox proportional hazard model were applied for the analyses., Results: The study population was followed for 24 months (2,692 person-months, N = 126). At the end of the follow-up, 27 patients were deceased. The two-year mortality rate was 10 per 1,000 person-month. Kaplan-Meier graphs showed that after approximately one year of follow-up, poorer survival was seen in patients with low CD8+, positive PARP, and positive EGFR. The adjusted analysis found staging as the main predictor of overall survival in TNBC (HR = 7.20, 95% CI= 2.07 - 25.00)., Conclusions: Patients with low CD8+, positive PARP, and positive EGFR expressions seem to be associated with poorer overall survival in TNBC. After approximately one year of follow-up, higher survival was observed in patients with high CD8+, negative PARP, and negative EGFR. Staging remains the main predictor of TNBC survival. Therefore, early detection and treatment of TNBC are essential to improve survival.

Background: Triple-negative breast cancer (TNBC) has been documented as the most aggressive subtype of breast cancer. This study aimed to analyze antitumor and protumor immune activities, and their ratios as significant prognostic biomarkers in metastatic TNBC (mTNBC)., Methods: A multicenter cohort study was conducted among 103 de novo mTNBC patients. The expression of CD8 and CD163 was evaluated using immunohistochemistry staining, CD4 and FOXP3 using double-staining immunohistochemistry, and PD-L1 using immunohistochemistry and RT-PCR., Results: Multivariate analysis revealed that high CD4/FOXP3 (HR 1.857; 95% CI 1.049-3.288; p = 0.034) and the CD8/CD163 ratio (HR 2.089; 95% CI 1.174-3.717; p = 0.012) yield significantly improved 1 year overall survival (OS). Kaplan-Meier analysis showed that high levels of CD4 (p = 0.023), CD8 (p = 0.043), CD4/FOXP3 (p = 0.016), CD8/FOXP3 (p = 0.005), CD8/CD163 (p = 0.005) ratios were significantly associated with higher rate of 1 year OS. Furthermore, 1 year OS was directly correlated with antitumor CD4 (R = 0.233; p = 0.018) and CD8 (R = 0.219; p = 0.026) and was indirectly correlated with protumor CD163 and FOXP3 through CD4/FOXP3 (R = 0.282; p = 0.006), CD4/CD163 (R = 0.239; p = 0.015), CD8/FOXP3 (R = 0.260; p = 0.008), and CD8/CD163 (R = 0.258; p = 0.009)., Conclusion: This is the first study to demonstrate that high levels of CD4/FOXP3 and CD8/CD163 significantly improved the 1 year OS in de novo mTNBC patients. Thus, we recommend the application of these markers as prognosis determination and individual treatment decision., (© 2024. The Author(s).)

Introduction: Advances in molecular biology bring advantages to lung cancer management. Moreover, high-throughput molecular tests are currently useful for revealing genetic variations among lung cancer patients. We investigated the genomics profile of the lung cancer patients at the National Cancer Centre of Indonesia., Methods: A retrospective study enrolled 627 tissue biopsy samples using real time polymerase chain reaction (RT-PCR) and 80 circulating tumour DNA (ctDNA) liquid biopsy samples using next-generation sequencing (NGS) from lung cancer patients admitted to the Dharmais Cancer Hospital from January 2018 to December 2022. Data were obtained from medical records. Data statistically analysed with p < 0.05 is considered significant., Result: The EGFR test results revealed by RT-PCR were wild type (51.5%), single variant (38.8%), double variant (8.3%), and triple variant (1.4%), with 18.66% L85R, 18.22% Ex19del, and 11.08% L861Q variant. Liquid biopsy ctDNA using NGS showed only 2.5% EGFR wild type, 62.5% single variant and 35% co-variant, with EGFR/TP53 and EGFR/PIK3CA as the highest., Conclusion: EGFR variants are the most found in our centre. Liquid biopsy with ctDNA using NGS examination could detect broad variants and co-variants that will influence the treatment planning., (© 2024. The Author(s).)

Background: Despite advances in lung cancer treatment, most lung cancers are diagnosed at an advanced stage. Expression of microRNA10b (miR-10b) and fibrinolytic activity, as reflected by soluble urokinase-type plasminogen activator receptor (suPAR) and plasminogen activator inhibitor 1 (PAI-1), are promising biomarker candidates., Objective: To assess the expression of miR-10b, and serum levels of suPAR and PAI-1 in advanced stage non-small cell lung cancer (NSCLC) patients, and their correlation with progression, treatment response and prognosis., Methods: The present prospective cohort and survival study was conducted at Dharmais National Cancer Hospital and included advanced stage NSCLC patients diagnosed between March 2015 and September 2016. Expression of miR-10b was quantified using qRT-PCR. Levels of suPAR and PAI-1 were assayed using ELISA. Treatment response was evaluated using the RECIST 1.1 criteria. Patients were followed up until death or at least 1 year after treatment., Results: Among the 40 patients enrolled, 25 completed at least four cycles of chemotherapy and 15 patients died during treatment. Absolute miR-10b expression ⩾ 592,145 copies/μL or miR-10b fold change ⩾ 0.066 were protective for progressive disease and poor treatment response, whereas suPAR levels ⩾ 4,237 pg/mL was a risk factor for progressive disease and poor response. PAI-1 levels > 4.6 ng/mL was a protective factor for poor response. Multivariate analysis revealed suPAR as an independent risk factor for progression (ORa⁢d⁢j, 13.265; 95% confidence intervals (CI), 2.26577.701; P= 0.006) and poor response (ORa⁢d⁢j, 15.609; 95% CI, 2.221-109.704; P= 0.006), whereas PAI-1 was an independent protective factor of poor response (ORa⁢d⁢j, 0.127; 95% CI, 0.019-0.843; P= 0.033)., Conclusions: Since miR-10b cannot be used as an independent risk factor for NSCLC progression and treatment response, we developed a model to predict progression using suPAR levels and treatment response using suPAR and PAI-1 levels. Further studies are needed to validate this model.

Background and Aim: Non-small cell lung cancer (NSCLC) is the most common lung cancer found in elderly patients. Aging and chronic inflammation are related to its pathogenesis. Functional status, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio describe a chronic inflammation and correlate to the survival of older adults with advanced-stage (IIIB-IV) NSCLC. This study aims to determine functional status, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio as prognostic factors to 1-year survival in elderly patients with NSCLC stage IIIB-IV., Methods: Survival analysis with a cohort retrospective study is conducted on elderly patients with NSCLC stage IIIB-IV in Dharmais National Cancer Center Hospital between January 2020 and June 2022. Medical records were collected, comprising complete blood count prior to chemotherapy or radiotherapy, assessment of functional status through the Barthel Index for Activities of Daily Living (ADL), and 1-year survival post-diagnosis. Factors potentially influencing outcomes included diabetes mellitus, anemia, chronic obstructive pulmonary disease, and chronic kidney disease. Statistical analyses were performed using SPSS 20.0, employing the log-rank method for bivariate analysis and Cox regression for multivariate analysis., Results: In a cohort of 108 patients, the majority were aged 60-69 years (74.1 %), male (66.7 %), diagnosed at stage IV (80.5 %), and with adenocarcinoma subtype (75.0 %). Significant correlations were observed between the lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio with the 1-year survival rate in elderly patients with stage IIIB-IV NSCLC (p = 0.015 and p = 0.001, respectively). Functional status did not show a significant correlation with 1-year survival overall (p = 0.540), but significant correlations were noted in patients receiving chemotherapy (p = 0.044) and radiotherapy (p = 0.009)., Conclusion: The lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio provide significant prognostic insights regarding 1-year survival in elderly patients diagnosed with stage IIIB-IV non-small cell lung cancer (NSCLC). In contrast, the functional status of these patients does not demonstrate a significant correlation with one-year survival., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The high mortality rate in breast cancer (BC) patients is generally due to metastases resistant to systemic therapy. Two causes of systemic therapy resistance in BC patients are circulating miRNAs-221 and miR-222, leading to improved BC cell proliferation, survival, and reduced cell apoptosis. This study investigated the miRNA expression changes associated with cancer cell resistance to tamoxifen therapy and is expected to be clinically meaningful before providing endocrine therapy to luminal-type BC patients who express them., Methods: This case-control research included individuals with the luminal subtype of BC who had received tamoxifen medication for around one year. Furthermore, the case group contained 15 individuals with local recurrence or metastases, while the control group comprised 19 patients without local recurrence or metastases. Plasma miR-221/222 quantification was performed with real-time PCR using transcript-specific primers., Results: A significant difference was found in circulating miR-221 expression between cases and controls ( P =0.005) but not in miR-222 expression ( P =0.070). There were no significant differences between miR-221/222 expression, progesterone receptor, Ki67 protein levels, lymphovascular invasion, and stage. However, receiver operator characteristic curve analyses showed miR-221/222 expressions predictive of tamoxifen resistance ( P =0.030) with a sensitivity of 60.00 and a specificity of 83.33%., Conclusion: The use of circulating miR-221/222 expression can predict relapse as well as resistance to tamoxifen treatment in BC patients, and their testing is recommended for luminal subtype BC patients who will undergo tamoxifen therapy to determine their risk of tamoxifen resistance early, increasing treatment effectiveness., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The survival rate in head and neck cancer varies among the subtypes, yet, the factors associated with survival between studies are still conflicting. This study aimed to investigate the association between pretreatment nutritional status, human papilloma virus (HPV) infection, tumor infiltrating lymphocyte (TIL), and treatment response after chemotherapy in patients with head and neck squamous cell carcinoma (HNSCC) in Indonesia. Further, factors associated with overall survival were also assessed., Methods: This was a retrospective cohort study. Data were collected between January 2015 and January 2018. A total of 30 patients with histopathologically proven squamous cell carcinoma head and neck cancer who had received at least three cycles of chemotherapy were included. Nutritional status was assessed using body mass index (BMI)., Results: The mean BMI was 21.8 kg/m 2 (Standard Deviation 3.98). The underweight patients had a higher risk of progressive disease (OR = 12.1, 95% CI = 1.1-135.6, P = 0.04) compared to patients with higher BMI. Neither HPV infection nor TIL was associated with treatment response and overall survival (P > 0.05). The median survival for the underweight patients was 9 months (95% CI = 3.00-15.00), whereas the median survival for normal and obese patients was 14 months (95% CI = 9.33-18.67)., Conclusion: Underweight is associated with a significantly higher risk of progressive disease and tends to have shorter overall survival in patients with HNSCC. Yet, neither HPV infection nor TIL was associated with treatment response and overall survival.

Objectives: One of the treatment modalities that can be used for hyperleukocytosis is leukapheresis. However, the result of studies showing the benefit of early mortality through the use of leukapheresis versus no leukapheresis is still inconclusive. Hence, we aimed to conduct a systematic review with meta-analysis to determine the effect of leukapheresis on early mortality in AML patients with hyperleukocytosis., Methods: We conducted a literature search on five databases (PubMed, EBSCOhost, Scopus, Clinicalkey, and JSTOR) up to October 2021 for studies comparing early mortality outcomes between hyperleukocytosis AML patients treated with leukapheresis versus no leukapheresis. Summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity tests were presented in I 2 value and publication bias was analyzed using a funnel plot., Results: Eleven retrospective cohort studies were eligible based on the inclusion and exclusion criteria. Pooled analysis showed that there was no significant difference in early mortality between patients receiving leukapheresis and not receiving leukapheresis in studies using hyperleukocytosis cutoff of 95,000/mm 3 or 100,000/mm 3 (OR: 1.17; 95% CI: 0.74-1.86; p : 0.50; I 2 : 0%). Similarly, studies using hyperleukocytosis cutoff of 50,000/mm 3 also showed no benefits of early mortality (OR: 0.67; 95% CI: 0.43-1.05; p : 0.08; I 2 : 0%). Most of the studies used had a moderate risk of bias due to being observational studies. Funnel plot showed an indication of publication bias on studies using hyperleukocytosis cutoff of ≥50,000/mm 3 ., Conclusion: The use of leukapheresis does not provide early mortality benefit in adult AML patients with hyperleukocytosis.

Background: Individuals' willingness to engage in advance care planning is influenced by factors such as culture and religious beliefs. While most studies on advance care planning in Asia have been performed in high-income countries, Indonesia is a lower-middle-income country, with a majority of strongly collectivist and religiously devout inhabitants. We studied the perspectives of Indonesian patients with cancer and family caregivers regarding advance care planning by first exploring their experiences with medical information-disclosure, decision-making, and advance care planning and how these experiences influence their perspectives on advance care planning., Methods: We conducted semi-structured interviews among 16 patients with cancer and 15 family caregivers in a national cancer center in Jakarta and a tertiary academic general hospital in Yogyakarta. We performed an inductive thematic analysis using open, axial, and selective coding. The rigor of the study was enhanced by reflective journaling, dual coding, and investigator triangulation., Results: Twenty-six of 31 participants were younger than 60 years old, 20 were Muslim and Javanese, and 17 were college or university graduates. Four major themes emerged as important in advance care planning: (1) participants' perceptions on the importance or harmfulness of cancer-related information, (2) the importance of communicating bad news sensitively (through empathetic, implicit, and mediated communication), (3) participants' motives for participating in medical decision-making (decision-making seen as patients' right or responsibility, or patients' state of dependency on others), and (4) the complexities of future planning (e.g., due to its irrelevance to participants' religious beliefs and/or their difficulties in seeing the relevance of future planning)., Conclusions: Culturally sensitive approaches to advance care planning in Indonesia should address the importance of facilitating open communication between patients and their families, and the various perspectives on information provision, bad news communication, and decision-making. Advance care planning should focus on the exploration of patients' values, rather than drafting treatment plans in advance., (© 2022. The Author(s).)

Background: Lung cancer is the most common cause of cancer-related death among men in the world. Given the very high mortality caused by lung cancer, a biological marker to determine a more sensitive therapy among non-small cell lung cancer (NSCLC) patients is needed. This study aims to demonstrate that the clinical laboratory result can be a prognosis marker in NSCLC patients in Indonesia., Methods: This study was a retrospective cohort study. The sample was obtained from the patient's serum and the examined routine blood test (hemoglobin, leukocyte, platelets), hemostasis (fibrinogen and D-dimers), blood chemistry test (aspartate transaminase [AST], alanine transaminase [ALT], albumin, urea, creatinine, and blood glucose), electrolyte (sodium, potassium, chloride, and calcium) and tumor markers (carcinoembryonic antigen [CEA] and Cyfra 21-1). Data were analyzed and interpreted using SPSS (IBM Corp., Armonk, NY, USA). Analysis of the data was done to find the survival rate of sociodemographic variables, clinicopathologic variables, and clinic laboratory variables., Results: The study findings showed statistically significant results that were poor prognosis for these following conditions: performance status (PS) 3-4 median survival (MS):26 days, p=<0.001; TNM stage IVb MS:58 days, p=0.001; high leukocyte MS:69 days, p=0.018; low platelet MS:50 days, p=0.013; high D-dimer MS:69 days, p=0.020; low albumin MS:56 days, p=0.001; high sodium MS:15 days, low sodium MS:50 days, p=<0.001; high chloride MS:15 days, low chloride MS:27 days, p=<0.001., Conclusion: In the advanced stage NSCLC, these findings indicate poorer prognoses; PS 3-4, IVb clinical stage, leukocytosis, thrombocytopenia, hyper-coagulopathy, hypoalbuminemia, hyper-hyponatremia, and hyper-hypochloremia. Further studies regarding the correlation between clinical laboratory and survival rate are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hanafi et al.)

Background: Most studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients., Methods: Focus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital., Results: We included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family's role in medical decision-making; 2) sensitivity to communication norms; 3) patients' and families' religious beliefs regarding the control and sanctity of life; and 4) the availability of a support system for advance care planning (healthcare professionals' education and training, public education, resource allocation, and formal regulation). Participants believed that, although family hierarchical structure and certain religious beliefs may complicate patients' engagement in advance care planning, a considerate approach to involving family and patients' religious perspectives in advance care planning may actually facilitate their engagement in it., Conclusion: Indonesian healthcare professionals believed that, for culturally congruent advance care planning in Indonesia, it was essential to respect the cultural aspects of collectivism, communication norms, and patients' religious beliefs., (© 2022. The Author(s).)

Introduction: Anemia is a common blood disorder in the elderly which is associated with numerous poor medical outcomes. However, there is currently no study that assesses anemia prevalence of the Indonesian elderly population aged ≥60 years old in multiple provinces and analyzes its association with handgrip muscle strength using a large sample size., Aim: We aimed to elucidate the prevalence of anemia and analyze factors associated with handgrip strength in elderly., Method: This was a cross-sectional study using data from the Indonesian Family Life Survey-5 (IFLS-5). All participants aged ≥60 years old were included in this study. Exclusion criteria were: (1) respondents who refused to take health measurements (hemoglobin (Hb) level, handgrip strength, weight, stature, and waist circumference); (2) respondents with incomplete or missing data; (3) respondents with history of stroke; and (4) respondents with history of pain, swelling, inflammation, injury, and surgery on one or both hands within the last 6 months. The dependent variable for this study was handgrip strength. Subjects were classified as weak if the handgrip strength was <28 kg for men and <18 kg for women based on classification from the Asian Working Group for Sarcopenia (AWGS) 2019. The independent variables were Hb level, gender, age, body mass index (BMI), waist circumference, smoking history, comorbidities, and current use of drug therapies. Based on WHO standard, male and female participants with Hb less than 13 g/dL and 12 g/dL, respectively, are defined as anemic. Statistical analyses used included correlation, bivariate logistic regression, and multivariate logistic regression., Result: A total of 3192 individuals were selected for analysis. Overall, 38.8% of participants had anemia, and the prevalence of anemia increases with age. A total of 56.30% of participants aged  ≥80 years had anemia. There was a positive correlation between Hb level and handgrip strength in the Indonesian elderly population (r: 0.349; p value: <0.001). Multivariate analysis showed that anemia was significantly associated with weak handgrip strength (OR: 1.557; 95% CI: 1.314-1.846; p value: <0.001).  Age ≥ 80 years (OR: 5.234), age 70-79 years (OR: 3.152), low BMI (OR: 1.827), and hypertension (OR: 1.340) were associated with weak handgrip strength in multivariate analysis., Conclusion: The prevalence of anemia in the Indonesian elderly was 38.8% and anemia was associated with weak handgrip strength. The association of anemia with weak handgrip strength is more pronounced in males and the elderly aged ≥80 years., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sutandyo et al.)

Objectives: we aim to conduct a systematic review and meta-analysis in population of adult MDS patients to elucidate the role of these genes in AML transformation risk., Materials and Methods: The protocol for this systematic review and meta-analysis was registered in the international prospective register of systematic reviews (PROSPERO) with ID number of CRD42020218581. Systematic literature search was conducted by all authors up to October 2021 on: (1) PubMed, (2) EBSCOhost, (3) Scopus, (4) JSTOR, and (5) grey literatures. Hand-searching for relevant articles was also conducted. The following keywords with their synonyms and combinations using Boolean operators were applied to all database: "myelodysplastic syndrome", SRSF2", "SF3B1", "U2AF1", "ASXL1", "DNMT3A", "TET2", "IDH1", "IDH2", "RUNX1", "acute myeloid leukemia progression", and "leukemia free survival". Outcome was measured using hazard ratio (HR)., Results: We identified 14 articles to be used for this systematic review and meta-analysis. There was no statistically significant difference in AML transformation risk between U2AF1 mutant and U2AF1 wildtype MDS patients (HR: 1.41; 95% CI: 0.95-2.07, p=0.08, I2=0%). Pooled HR showed that patients with SRSF2 mutation had higher risk of AML transformation (HR 2.62; 95% CI: 1.54-4.45; p= .0004; I2= 55%). The pooled HR for SF3B1 was 0.48 (95% CI: 0.22-1.06, p=0.07, I2=55%). Mutations of TET2, ASXL1, and EZH2 were not associated with AML transformation. Meanwhile, DNMT3A mutations were associated with AML transformation with pooled HR of 2.73 (95% CI: 1.43-5.21; p= 0.08; I2: 67%). The pooled HR for IDH genes was smaller (HR: 2.92; 95%CI: 1.21-7.06; p=0.02; I2:65%). Patients with RUNX1 mutation were associated with AML transformation (HR: 1.85; 95%CI: 1.11-3.09; p=0.02; I2:38%)., Conclusion: Based from our analyses, MDS patients with mutations of SRSF2, DNMT3A, IDH, and RUNX1 have higher hazard ratio for AML transformation.

Background: Around 70% of breast cancers (BCs) are estrogen receptor-α (ERα)-positive. Adjuvant endocrine therapy is used to reduce estrogen levels and inhibit signal transduction through the ER. The anti-estrogen drugs that are most commonly used in endocrine therapy belong to the selective ER modulator (SERM) class and include tamoxifen. Although it has been used for three decades in cases of early-stage and ERα-positive BC, resistance to tamoxifen is a common problem. microRNAs (miRNAs) have a potential role in demonstrating BC resistance to tamoxifen therapy. Hence, there is a need to investigate the expression of miRNA-221 (miR-221) in luminal-subtype BC patients receiving tamoxifen therapy., Methods: This case-control study investigated luminal-subtype BC patients who had undergone endocrine therapy for at least 1 year. The case group comprised patients with local or metastatic recurrence, and the control group comprised patients without local or metastatic recurrence., Results: There was a significant difference in miR-221 expression ( p  = 0.005) between the case and control groups. There were no significant differences between the groups that were positive and negative for the progesterone receptor (PR) ( p  = 0.25), had high and low marker of proliferation Ki-67 levels ( p  = 0.60), were positive and negative for lymphovascular invasion ( p  = 0.14), and had stage 2 and stage 3 cancer ( p  = 0.25)., Conclusion: miR-221 expression was higher in tamoxifen-resistant BC cases. miR-221 is a potential biomarker of tamoxifen resistance., (© 2021 The Authors.)

Background: This study aims to evaluate the association and dose-response between triglyceride-glucose (TyG) index and breast cancer., Method: This is a multicenter case-control study conducted in six public referral hospitals in Indonesia. Cases are individuals aged 19 years or above who were diagnosed with breast cancer within 1 year of diagnosis, based on histopathology and immunohistochemistry. Controls were recruited from corresponding hospitals. TyG index was determined by the formula: ln (fasting TG [mg/dl] × fasting glucose [mg/dl])., Results: There were 212 participants in the breast cancer group and 212 participants in the control group. TyG index was higher in patients with breast cancer (median 8.65 [7.38, 10.9] vs. 8.30 [7.09, 10.84], p < 0.001). When compared with TyG quartile of Q1, Q4 was associated with an OR of 2.42 (1.77, 3.31), p < 0.001, Q3 was associated with an OR of 1.53 (1.21, 1.93), p < 0.001, Q2 was associated with an OR of 1.39 (1.12, 1.73), p = 0.002 for the risk of breast cancer. The dose-response relationship was nonlinear ( p < 0.001). On univariate analysis, smoking (OR 2.15 [1.44, 3.22], p < 0.001), use of contraception (1.73 [1.15, 2.60], p = 0.008), alcohol consumption (OR 2.04 [0.96, 4.35], p = 0.064), and TyG Index >8.87 (OR 3.08 [1.93, 4.93], p < 0.001) were associated with risk of breast cancer. Independently associated with increased risk of breast cancer included smoking (OR 1.93 [1.23, 3.01], p = 0.004), use of contraception (OR 1.59 [1.02, 2.48], p = 0.039), and TyG Index >8.87 (OR 2.93 [1.72, 4.98], p < 0.001)., Conclusion: TyG index was associated with breast cancer in a nonlinear dose-response fashion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Panigoro, Sutandyo, Witjaksono, Siregar, Ramli, Hariani, Pangarsa, Prajoko, Puruhita, Hamdani, Bayu, Madjid, Yulidar, Fransiska, Widyawati, Tripriadi, F. W., Yunda and Pranata.)

Background: In this study, we aimed to investigate whether FIB-4 index is useful in predicting mortality in patients with concurrent hematological malignancies and COVID-19. We also aimed to determine the optimal cut-off point for the prediction., Methods: This is a single-center retrospective cohort study conducted in Dharmais National Cancer Hospital, Indonesia. Consecutive sampling of adults with hematological malignancies and COVID-19 was performed between May 2020 and January 2021. COVID-19 screening test using the reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal samples were performed prior to hospitalization for chemotherapy. FIB-4 index is derived from [age (years) × AST (IU/L)]/[platelet count (109/L) × √ALT (U/L)]. The primary outcome of this study is mortality, defined as clinically validated death/non-survivor during a 3-months (90 days) follow-up., Results: There were a total of 70 patients with hematological malignancies and COVID-19 in this study. Median FIB-4 Index was higher in non-survivors (13.1 vs 1.02, p<0.001). FIB-4 index above 3.85 has a sensitivity of 79%, specificity of 84%, PLR of 5.27, and NLR of 0.32. The AUC was 0.849 95% CI 0.735-0.962, p<0.001. This cut-off point was associated with OR of 16.70 95% CI 4.07-66.67, p<0.001. In this study, a FIB-4 >3.85 confers to 80% posterior probability of mortality and FIB-4 <3.85 to 19% probability. FIB-4 >3.85 was associated with shorter time-to-mortality (HR 9.10 95% CI 2.99-27.65, p<0.001). Multivariate analysis indicated that FIB-4 >3.85 (HR 4.09 95% CI 1.32-12.70, p = 0.015) and CRP> 71.57 mg/L (HR 3.36 95% CI 1.08-10.50, p = 0.037) were independently associated with shorter time-to-mortality., Conclusion: This study indicates that a FIB-4 index >3.85 was independent predictor of mortality in patients with hematological malignancies and COVID-19 infection., Competing Interests: The authors have declared that no competing interests exist.

Almost half of cancer patients experience cachexia syndrome. Cachexic patients are at risk of increased side effects of chemotherapy, reduced tolerance to chemotherapy drugs, longer duration of treatment period, and decreased quality of life. Cancer cachexia is a multifactorial syndrome. Micro ribonucleic acid (miRNA), a "non-coding RNA", is considered to be a risk factor of cachexia and muscle wasting in cancer patients. miRNA has a role in affecting protein regulation, associated with different inflammatory and disease pathways. miRNA can also affect cytokines or directly change the regulation of metabolism that lead to cachexia. In this review, we want to focus on the pathophysiology to give a better understanding about the role of miRNA in the development of cancer cachexia. Based on various pathways of miRNA in cancer cachexia, it can be a potential target for therapeutic strategies. Improved knowledge about miRNA can give the opportunity to develop new treatment in the management of cancer cachexia., (Copyright © 2020, Babol University of Medical Sciences.)

Background: Squamous cell carcinoma of the oral cavity (OSCC) is the sixth most common malignancy. Surgery is mainstay treatment for oral cancers. Surgery in locally advanced OSCC presents many challenges primarily because the head and neck have critical structures that can be damaged by tumor or treatment. It is thought that neoadjuvant chemotherapy (NC) in locally advanced OSCC is able to shrink tumor size. Chemoresistancy is a problem due to hypoxic microenvironment characterized by increased expression of HIF-1α. It is also regulated by miR-210 as well as increased expression of CD44 and CD133. Melatonin has a powerful antioxidant and oncostatic effects that are expected to improve tumor hypoxia and clinical response. Fifty patients with OSCC were included and randomized. miR-210 and CD44 expression were measured before and after intervention using qRT-PCR absolute quantification, and clinical response was evaluated according to RECIST 1.1 criteria. This study aims to determine the effect of melatonin in improving the clinical response of patients with locally advanced oral squamous cell carcinoma (OSCC) after neoadjuvant chemotherapy to miR-210 and CD44 expression., Results: Melatonin administration reduced miR-210 levels but not significant (p = 0.767). CD44 expression also decreased in the melatonin group compared with placebo yet was not significant (p = 0.103). There was a decrease in the expression of miR-210 and CD44 followed by a decrease in the percentage of residual tumor but not significant (p = 0.114)., Conclusion: In OSCC, the addition of 20-mg melatonin to neoadjuvant chemotherapy (NC) reduced the expression of miR-210 and CD44 and decreased the percentage of tumor residue; however, no statistically significant result was observed., Trial Registration: This study is registered to ClinicalTrials.gov under trial registration number: NCT04137627 with date of registration on October 22, 2019-retrospectively registered, accessible from: https://clinicaltrials.gov/ct2/show/NCT04137627.

Background: the number of elderly people in Indonesia is increasing. Additionally, cancer prevalence among older patients is also increasing. However, studies assessing clinical factors associated with the survival of elderly patients with cancer are still lacking. This study aimed to investigate the survival of geriatric patients with cancer and associated factors., Methods: this was a retrospective cohort study. Subjects were geriatric patients with cancer aged >60 years, enrolled between 2013 and 2015 in Dharmais Cancer Hospital. Data were retrieved from medical records and consisted of gender, age, cancer type, stage, Eastern Cooperative Oncology Group (ECOG) performance status (PS), body mass index (BMI), Charlson Comorbidity Index, and type of treatment. Cox regression analysis was used to identify independent prognostic factors for survival., Results: a total of 249 patients were enrolled, with a median age of 66 (60-85) years. The most common cancer was of the lung, followed by breast, colorectal, and uterine cervical cancers. The median survival time was 24 months. Cox multivariate analysis was performed by gender stratification. Advanced stage cancer (III-IV) was identified as the risk factor for mortality in female patients (hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.53-4.80; p = 0.001), while poor performance status (ECOG 2 - 4) was the risk factor in male group (HR 1.82; 95% CI 1.01-3.24; p = 0.04)., Conclusion: the survival of elderly patients with cancer is affected by traditional prognostic factors. Advanced cancer stage was significant independent prognostic factor in female patients, while poor performance status was significant in male patients.

Background: EGFR-tyrosine kinase inhibitors (EGFR-TKIs) were used to treat non-small cell lung cancer (NSCLC) patients with EGFR mutation positive. This study aims to compare the effectiveness of first line TKIs; gefitinib, erlotinib, and afatinib in the treatment of advanced stage NSCLC patients with EGFR mutation positive in the Indonesian population., Methods: A retrospective cohort study of 88 NSCLC patients with EGFR mutation positive treated with gefitinib (n=59), erlotinib (n=22), and afatinib (n=7) was performed in national cancer hospital in Indonesia.Inclusion criteria were stage IIIb or IV NSCLC with adenocarcinoma subtype. Subjects less than 18 years or with a history of other malignancy were excluded. Outcomes were treatment response, progression-free survival (PFS), and mortality rate., Results: Complete response, partial response, and stable disease were shown in 1.1%, 35.2%, and 31.8% of subjects, respectively. There were 31.8% of subjects developed progressive disease during treatment. Regarding EGFR mutation positive profile, a total of 56.8% subjects had deletion in exon 19, 42% subjects had mutation in exon 21, and rare mutation in exon 18 was found in 3.4% of total subjects. Demography and clinical characteristics had no significant association with the risk of progressive disease. The median PFS of subjects was 11 months (95%CI: 6.8-15.2 months). There was no statistical difference of PFS between treatment groups.
 CONCLUSIONS: Gefitinib, erlotinib, and afatinib have similar effectiveness in advanced stage NSCLC with EGFR mutation positive. Afatinib tends to be associated with longer PFS but further investigation is required.

Background: the increasing incidence of lung cancer in female patients has been observed in Indonesia. Lung cancer in female might have different biology process than male, but it has never been evaluated in Indonesia. This study aimed to know characteristics and survival of female patients with non-small-cell lung carcinoma (NSCLC) in Dharmais National Cancer Centre Hospital., Methods: a retrospective cohort study was performed among NSCLC female patients in Dharmais Cancer Hospital (DCH) between January 2005 and December 2015. Survival analysis was done using the Kaplan-Meir estimation curve with proportional assumption test. Independent prognostic factors were analyzed using the Cox proportional hazard model with a hazard ratio (HR) and its 95% confidence interval (CI)., Results: a total of 956 NSCLC cases were retrieved during the study; 268 (28.0%) were female patients. Mean of age in female patients was 56.9 (11.87) years old. Among female patients, 21 (7.8%) were smokers, 244 (91.1%) had adenocarcinoma subtype, and 261 (98.0%) were in advanced stage (III-IV). Median survival was slightly longer in female than male patients (14.9 months vs. 12.2 months; log-rank p=0.055). Significant prognostic factors for survival were older age (>50 y.o) (HR = 0.681; 95% CI = 0.467 - 0.992; p= 0.045) and positive eGFR mutation (HR = 0.393; 95% CI = 0.251 - 0.615; p<0.001)., Conclusion: female patients contributed to about 28% of all NSCLC cases. They were mostly non-smokers, have more adenocarcinoma histopathology and eGFR mutation. Survival tended to be longer in female than male patients. Age over 50 years and the presence of eGFR mutation were good prognostic factors to survival in female lung cancer patients.

Cancer prevalence is increasing every year and now cancer is the third highest cause of death in developing countries. Effective anticancer treatment can prolong life and improve the patient's quality of life. Targeted therapy is a new therapeutic modality which targets specific molecules in the cancer cell and disrupts dysregulated signaling pathways involved in carcinogenesis. Since targeted therapy does not attack normal cells, its side effects are considered low compared to chemotherapy. More than 15 drugs have been approved for treatment in various human cancers. These drugs can largely be grouped into tyrosine kinase inhibitors and monoclonal antibodies. This review will focus on the most common agents within both groups.

Background: Even though rarely found in Indonesia, the incidence of multiple myeloma (MM) is increasing every year. Bone involvement of MM is the most often a clinical disorder which leads to worsening clinical conditions and low quality of life of patients., Purpose: To determine the clinicopathology profile of bone involvement of MM patients in Indonesia., Materials and Methods: The cross-sectional study of MM conducted at Dharmais National Cancer Hospital (DNCH) by collecting data from medical records of MM patients who came to DNCH in period 2008-2012., Results: There were 39 MM patients all with age above 60 years. There were 56.4% male and 43.6% female patients. Most were diagnosed at stage III (32.4%), and 41% had obesity. The comorbid conditions were anemia (82.9%), hypoalbuminemia (60%), increased creatinine level (38.5%), increased β2 microglobulin level (94.1%), increased LDH level (23.1%) and plasmocytes above 30% (65%), but only 4.2% patients presented with hypercalcemia. Meanwhile, bone involvement occurred in 76.9% of MM patients with 4 lesions on average and a maximum of 16 lesions. The locations of bone lesions were spine (70%), skull (70%), pelvis (33.3%), humerus (30%), and femur (30%)., Conclusions: The incidence of MM in Indonesia is increasing annually with bone involvement in more than three-fourths, but interestingly without hypercalcemia.

Background: Cisplatin is still used as a first-line medication for solid tumors. Nephrotoxicity is a serious side effect that can decrease renal function and restrict applicable doses. This research aimed to obtain the profile of cisplatin-induced nephrotoxicity and its associated factors in adult cancer patients at Dharmais National Cancer Hospital (DNCH)., Materials and Methods: The design was cross-sectional with data obtained from patient medical records. We retrospectively reviewed adult cancer patients treated with cisplatin ≥60mg/m2 for at least four consecutive chemotherapy cycles from August 2011 to November 2013. The nephrotoxicity criterion was renal function decline characterized by creatinine clearance <60 ml/min using the Cockroft-Gault (CG) equation., Results: Eighty-eight subjects received at least four chemotherapy cycles of cisplatin. The prevalence of cisplatin nephrotoxicity was 34.1%. Symptoms could be observed after the first cycle of chemotherapy, and the degree of renal impairment was higher with increased numbers of cycles (r=-0.946, r2=89.5%). Factors that affected the decline of renal function were patient age (p=0.008, OR=3.433, 95%CI= 1.363-8.645) and hypertension (p=0.026, OR=2.931, 95%CI=1.120-7.670)., Conclusions: Cisplatin nephrotoxicity occurred in more than one-third of patients after the fourth cycle of chemotherapy and worsened after each cycle despite preventive strategies such as hydration. The decline of renal function induced by cisplatin ≥60 mg/m2 was affected by age and hypertension.

Background: Tongue cancer is still a major health problem in most developing countries around the world. Statistics shown the number of tongue cancers, especially in early age, to be increasing, with poor survival., Objective: To analyze the characteristic profile of tongue cancer patients in Indonesia as well as the survival rate., Materials and Methods: A cross sectional study was conducted in Dharmais National Cancer Hospital by collecting general, clinical, and survival data of tongue cancer patients from medical records for January 2009 to April 2012., Results: Tongue cancer incidence increased year by year. The average age of tongue cancer patients was 47.5 years, and males predominated, accounting for 64.5% of cases. Most patients presented at an advanced stage (69.6%). The histopathology type was squamous cell carcinoma in the vast majoriy (96.8%). The therapies applied were surgery (45.6%), radiation (63.6%) and chemotherapy (57.6%). The survival rate after one year is 60.6% and after two years was 12.1%. In addition, median survival of tongue cancer patients was 20 months (95% confidence interval 9.07-30.9). The significant factor affecting survival was size of tumor with a hazard ratio of 3.18 (95% CI, 1.02-9.93; p 0.046) for largest versus smallest categories., Conclusions: In each year, the number of tongue cancer incidents in Indonesia is increasing. The age of tongue cancer patients in Indonesia is younger compared to other countries. Moreover, the survival rates are not high.

Human beings are often being exposed to carcinogenic factors during their life, some of which are the nutritional factors. From the mechanistic view, nutritional factors are classified into genotoxic and non-genotoxic agents. Genotoxic agent begins their action at the DNA level, causing DNA damage through several mechanisms, e.g. gene point mutations, deletions and insertions, recombinations, rearrangements and amplifications, as well as chromosomal aberrations. Most genotoxic agents are micro components of nutrition, i.e. polycyclic aromatic hydrocarbon (PAH) or heterocyclic amines (HCAs), aflatoxin, and N-nitrosamine. Non-genotoxic agents are less defined in their modes of action, but they are presumed to indirectly affect the cell through tumor promoters. These agents are generally macro components, e.g. high fat. Moreover, epigenetic factors, including changes in the DNA methylation pattern, and peroxidation process resulting reactive oxygen species (ROS), are also known to cause cancer. On the other hand, it is also well recognized that diet and nutrition contain components that can reduce the risk of cancer, in some cases by decreasing the effects of food mutagens, or through carcinogen detoxification, or protection of DNA from electrophilic carcinogen. Thus nutritionally related cancer ultimately develops from an imbalance of carcinogenesis and anti-carcinogenesis process.

Aim: to determine signaling pathways in breast cancers from patients aged 35 years old or younger and patients aged more than 35 years old., Methods: this was a cross-sectional, comparative study of female breast cancer patients who were recruited and divided into two age groups, i.e. 35 years or younger and more than 35 years old. Specimens were obtained by biopsy or surgical removal of the tumors and were confirmed by histopathological examination. The expression of ER, IGF-1R, Her-2, MAPK, and cyclin D1 were measured using immunohistochemistry., Results: ninety-three patients were recruited from September 2004 to December 2005. Forty-three patients were 35 years or younger. More than 90% of the patients within the two groups showed invasive ductal carcinomas and more than half of these tumors were grade 2. Immunohistochemical staining was successfully done in 90 patients. ER-alpha expression was negative in 33 breast cancers (78.6%) from patients less than 35 years old and 32 cancers (66.7%) of older patients. The expressions of IGF-1R, Her-2, MAPK, and cyclin D1 were positive, respectively in 17 (40.5%), 11 (26.2%), 28 (66.7%), and 7 (16.7%) cancers within the group of patients 35 years old or younger, and, respectively in 18 (37.5%), 11 (22.9%), 37 (77.1%), and 9 (18.8%) of cancers from patients more than 35 years old., Conclusion: there were no statistically significant differences in the expression of any of the biomarkers between the two groups. In all patients, ER was negative in 72.2% cases and MAPK was positive in 76.7% cases. Patients aged 35 years or younger showed similar ER, IGF-1R, Her-2, MAPK, and cyclin D1 expressions compared to cancers from patients more than 35 years old. These were predominantly ER-negative, suggesting that estrogen does not play a dominant role in their growth. The frequent expression of MAPK in these cancers raises the possibility that growth factors play a dominant role in their growth.