13 research outputs found
Recent Management of Patients with Advanced Epidermal Growth Factor Receptor Mutation Non-small Cell Lung Cancer: Role of Afatinib and Lesson Learned for Developing Countries
Full text linkLung cancer is a devastating disease with a high incidence, mortality and morbidity rate, especially in developing countries. Conventional treatment with cytotoxic chemotherapy has some limitations attributed to chemoresistance and toxicity. Recent advances have shown that first generation Tyrosine Kinase Inhibitor (TKI), Gefitinib and Erlotinib, and the newest available second generation Tyrosine Kinase Inhibitor (TKI), Afatinib, have the potential to be an option in the management of patients with epidermal growth factor receptor/ EGFR mutation positive advanced/ metastatic non-small cell lung cancer. Afatinib works by binding to EGFR irreversibly, thus inactivating the tyrosine kinase receptor. Some studies demostrated that Afatinib first-line may result in longer progression free survival (PFS) and better disease control, and as an alternative for patients who intolerance to Gefitinib or Erlotinib. In Indonesia, the era of National Health Insurance has been implemented and National Health Insurance has covered treatment for cancer, including first generation TKIs, Gefitinib dan erlotinib, for patients with EGFR mutation positive advanced/ metastatic non-small cell lung cancer at Cipto Mangunkusumo National Hospital. Afatinib, as one of the newest available second generation TKI, may be given free of charge too as an alternative if the National Health Insurance will be covered in the future. Further research is needed to know the efficacy and adverse effects that may occur in patients from developing countries.
Combining oncolytic virus and radiation therapy for cancer management
No full textCancer has caused a tremendous burden in developing countries. Oncolytic virus (OV) therapy is an emerging modality with the potential to be a single or combination agent with radiation therapy (RT). Following entry of OV to the cell, OV will replicate and assemble before exiting from tumor cells. Construction of OV can be done by modifying the capsid, genome, and chemical material of viruses. Irradiation will induce double-strand breaks, and further integration of OV with DNA damage response pathway will interact with the MRE11-Rad50-Nbs1 complex to regulate the mobilization of E4 open reading frame 6, protein phosphatase 2A, poly(ADP-ribose) polymerase, apoptosis-inducing factor, and topoisomerase-IIβ-binding protein 1. Degradation of DNA-dependent protein kinase catalytic subunits via human simplex virus-1-infected cell polypeptide 0 will inhibit DNA repair. OV and RT have a synergistic interaction to cause viral oncolysis and upregulation of immune response. In the clinical setting, most studies have demonstrated that OV is a safe treatment with less toxicity. Moreover, OV + RT resulted in longer median survival (62.4 vs. 37.7 weeks) in malignant glioma
Ulinastatin as a Potential Alternative Therapy for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Full text linkStevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) is an emergency skin disease with high mortality rates despite the incidence rate is not great. Patients with SJS/TEN will experience reduced quality of life due to the pain experienced when eating, drinking or urinating. There is not a specific treatment for patient with SJS/TEN so far. Corticosteroids and intravenous immunoglobulin (IVIG) are the most commonly used therapies yet there are still controversies due to their positive and negative effects. Ulinastatin, a trypsin inhibitor and an anti-inflammatory compound that is made from human urine is a therapeutic option for SJS/TEN. Ulinastatin may provide anti-inflammatory effect by inhibiting TNF-α production, thereby reducing the risk of septic complications and lowering mortality. Until now, the known side effects are nausea, vomiting and allergic to gelatin. Although it has a promising potential, the effectiveness of ulinastatin is still poorly studied. Further research is needed regarding the usage of ulinastatin on patients with SJS/TEN
The challenge of the implementation and evaluation of hospital-based cancer registry in Indonesia’s national referral hospital
No full textBACKGROUND To lower the burden caused by cancer, the Ministry of Health of the republic of Indonesia requires valid data collection to plan and evaluate cancer programs. This study aimed to evaluate the challenge of developing a cancer registry (CanReg) in Cipto Mangunkusumo Hospital.
METHODS This was an observational study on the implementation of cancer registration from the initial licensing until the creation of valid and accurate data, also the challenges in implementing hospital-based cancer registry (HBCR) in Cipto Mangunkusumo Hospital.
RESULTS Cancer registry was developed in 2016 using the 2013 Indonesian version of CanReg5 program called SriKandI. We identified some problems in this registry implementation, such as legal and human resources, medical records, electronic health records, and the CanReg5 program. Moreover, this team processed 886,086 raw patients’ data with fairly good topography and age data completeness.
CONCLUSIONS Several obstacles were encountered upon the establishment of HBCR at Cipto Mangunkusumo Hospital from program to bureaucracy and resources. Nevertheless, CanReg data can be used as a basis for decision making by stakeholders
Gene polymorphism impact on opioid analgesic usage
No full textAcute pain, moderate-to-severe cancer pain, and persistent malignant pain are all frequently treated with opioids. It is regarded as one of the main tenets of analgesic treatment. The relationship between human opioid sensitivity and genetic polymorphism differences has received little attention up to this point in research. Nonetheless, there is mounting proof that pharmacogenomic diversity could affect how each person reacts to opioids. Finding out how gene polymorphism affects analgesic use is the aim of this investigation, particularly opioids. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed in the preparation of the systematic review approach used in this work. Oxycodone, fentanyl, raclopride, tramadol, ketorolac, morphine, ropivacaine, levobupivacaine, subfentanyl, remifentanil, and nortriptyline were the opioid medications used in the study, which was based on 13 publications. From those articles, we reviewed the impact of gene polymorphism on pain management and drug pharmacokinetics. Based on this systematic review, we concluded that gene polymorphism of gene affects analgesic, specifically opioid mechanisms
Role of Radiotherapy in Liver Tumors: Recent Update
No full textHepatocellular carcinoma (HCC) is the most common primary tumor with an increased risk of mortality and morbidity. Treatment for HCC varies based on the progressivity of disease. Radiotherapy such as stereotactic body radiotherapy (SBRT) plays an important role in the treatment of HCC. The role of radiotherapy used to be very limited to liver tumors, but recently, radiotherapy with SBRT technique has shown very promising results, both in primary liver cancer and liver metastasis. This review shows the role of radiotherapy in HCC for every stage of HCC (monotherapy, combined or bridging therapy). In liver metastasis cases, radiotherapy shows an excellent, similar, and better local control when compared with radiofrequency ablation (depending on tumor status)
Colorectal cancer radiotherapy utilization rate in a low-middle income country – a multicenter study in Indonesia
No full textTackling Resistance to Cancer Immunotherapy: What Do We Know?
No full textCancer treatment has evolved tremendously in the last few decades. Immunotherapy has been considered to be the forth pillar in cancer treatment in addition to conventional surgery, radiotherapy, and chemotherapy. Though immunotherapy has resulted in impressive response, it is generally limited to a small subset of patients. Understanding the mechanisms of resistance toward cancer immunotherapy may shed new light to counter that resistance. In this review, we highlighted and summarized two major hurdles (recognition and attack) of cancer elimination by the immune system. The mechanisms of failure of some available immunotherapy strategies were also described. Moreover, the significance role of immune compartment for various established cancer treatments were also elucidated in this review. Then, the mechanisms of combinatorial treatment of various conventional cancer treatment with immunotherapy were discussed. Finally, a strategy to improve immune cancer killing by characterizing cancer immune landscape, then devising treatment based on that cancer immune landscape was put forward
