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CANCER RESEARCH

IN INDONESIA

Arry Haryanto
Sofia Mubarika
Jakarta, 10 November 2008
Cancer Research

 Cancer is the 3th killer diseases in


Indonesia
 Cancer Research integrated/multidisciplin
 Research facilities & grants – sufficient
 Researchers – team work from basic, clinic,
public health
 Impact to decision making process- early
screening, prevention , vaccination
Mapping Research Cancer in Indonesia ??
Depdiknas DepKes KMNRT

LITBANGKES CoE
CoE UI LIPI CoE
RSK Dharmais
CoE UNPAD
Eijkman CoE
CoE UNDIP CoE
Cancer BPPT CoE
CoE hosp
UGM
CoE CoE
UNAIR LAPAN
CoE
UNHAS CoE
BATAN
CoE
USU dll
Bakosurtanal CoE
RS tipe A, B, C BMG
• Cancer Research
• Acuan ARN/Litbangkes
• Preventif
• Diagnostic/Prognostic
• Treatment

Visi dan Misi Penelitian tidak


repetitif
SDM, Expertise Institusi
Synergi SDM,
CoE fasilitas
Prog. Unggulan
Networking :
Infrastructure Info hasil penelit
Hsl Penelitian
SDM – Outsourcing
-Indonesia
Kolaborasi N/Intl Fasilitas
publikasi,recognisi
Multicenter study
-A – B - G
Cancer:
Networking VUmc AvL IGR KI Austr &others
Issues on cancer
research……
 Rapid development on medical scien-
tech
 Grants : National vs international
 Networking and communication -
national & international
 Sharing knowledge, ideas, facilities
 Synergy between Institution –
Business – Government
 International Publication
Could it be happened…….??
We the people . . . .
wish that clinical and translational research can be
interwoven,
in order to form a more perfect
Union between clinical care and research endeavors.

.
TRANSLATIONAL
RESEARCH

From basic to clinical application


 Research based on clinical /community problems
 back to clinical / community benefit
Strategic Priorities

 National Cancer Registry

 Basic Research

 Translational Research
Translational research
 from basic to clinic
 from bench to bedside
 integrated
 multidisciplin
 FCC, NPC, Leukemia, Colon ca
Clinical Benefit of
Translational Research
 Better diagnosis
 Better predictive outcome
 Better treatment
 Provide patient’s safety
Data 10 Kanker Terbanyak
di RS Kanker ‘Dharmais’ Tahun 2007
Jenis Tumor Jumlah Persentase
Kasus (%)
Tumor Payudara 437/1348 32,4
Tumor Serviks 254/1348 18,8
Tumor Kolorektal 121/1348 9
Tumor Paru 113/1348 8,4
Tumor Nasofaring 104/1348 7,7
Tumor Hati 76/1348 5,6
Limfoma 62/1348 4,6
Leukemia 62/1348 4,6
Tumor Tiroid 62/1348 4,6
Tumor Ovarium 57/1348 4,2
Data 10 Tumor Ganas Terbanyak
di RS Dr. Sardjito Yogyakarta Tahun 2004
Jenis Tumor Jumlah Persentase
Kasus (%)
Tumor Serviks 103/479 21
Tumor Payudara 78/479 16
Tumor Nasofaring 67/479 14
Tumor Kolorektal 63/479 13
Tumor Kulit 41/479 8,4
Tumor Limfonodi 40/479 8,3
Tumor Vesikaurinaria 31/479 6,47
Tumor Prostat 21/479 4,38
Tumor Ovarium 18/479 3,76
Tumor Tiroid 17/479 3,55
STUDIES ON CANCER

EPIDEMI- PREVEN- CURATIVE DIAGNOSTIC MECHANISM


LOGY TION

1. Risk 1. Diagnostic Protein,RNA, Biological


Factor 1. Vaccine Target
DNA
2. Therapy
2. Etiology 2. Nutrition&
a. Natural Product
Supplement
b. Synthetic Products
c. Drug Formulation
3. Survei- 3. Environ-
llance& ment d. Clinical Trial
Incidence e. Cost Assessment

3. Palliative
4. Genetic 4. Culture

4. Rehabilitative

5. Psychology
International research
collaboration on breast cancer

GMU – UI - Dharmais – UNUD – UNHAS


Groningen – VUmc - Utrecht - IARC
Breast cancer clinic in
Indonesia
From bench to bed site
Team: Collaborator:
•Teguh Aryandono – UGM •Gerard pals – VUmc, NL
•Kunta Setiadji – UGM •Paul van Diest – Utrecht
•Lina Choridah – UGM •Hoekstra – RUG
•Dewayani Purnomosari – UGM Et al.
•IB Tjakra Wibawa – UNUD
•Samuel Haryono – Dharmais Cancer Hospital
•Daniel Sampepayung – UNHAS
•Noorwati – Dharmais Cancer Hospital
•Aru Sudoyo-UI
Aim
 Develop new approach in diagnosis and
prognosis of breast cancer cases
 Early screening and treatment for hereditary
breast cancer family
 Genetic epidemiology of hereditary breast
cancer, collaboration among breast cancer
centers in Indonesia
 Discover new susceptible gene for hereditary
breast cancer, the BRCAx
Risk factors
 Way of life
 Environment :
 Genetic:
 BRCA 1/2/X
 Epigenetic :
 hypermethylation on promoter of TSG’s
Genetic factors
 BRCA 1&2 - high risk families

 Evidences from Indonesia :


 Polymorphism (established)- Breast Cancer
Information Core
 BRCA 1 : mutations on exon 13 and 16
 BRCA 2 : mutations on exon 2 and 14
 Novel mutation :
 6 bp deletion in exon 11 BRCA 2  premature
stop
Gene responsible- susceptibility
 BRCA 1 – 5592 bp, 22 exons, encode
1863 a.a.
 BRCA 2 – 10433 bp, 26 exons, 3418 a.a

 >80% of families with 2/> premenopausal


Breast Ca & 2/> ovarian Ca – germ line
BRCA1/2 mutations
Breast cancer translational research
networking
Gadjah Mada
University, Sardjito
Hospital Free University
Medical Center,
Amsterdam
Dharmais Cancer
Hospital
Utrecht Medical
Center
Udayana University,
Sanglah Hospital
University Medical
Center Groningen
Hassanudin
University
Cancer risk assesment :
 How is the efficiency and accuracy of genetic
screening methods ?

 Need to have a standardized techniques


 - accurate and inexpensive

 DGGE – denaturing gradient gel electrophoresis


& targeted sequencing
 rely on recognition seq variation –basis of altered
electrophoretic mobility pattern –
Translational Research on
Nasopharyngeal carcinoma
from bench to bedside
 Most prevalent cancer
in men
 Most prevalent head
and neck cancer
 Majority of patients
present in advanced
disease
 Poor prognosis
 Better management is
absolutely needed !
Team
 Sofia Mubarika – PI - UGM  Pierre Busson – IGR, Fr
 B. Hariwiyanto - ENT/UGM  Rina Susilowati –Histo - UGM
 Indwiani Astuti – Biomol,UGM  Dyah Wulan –Biomol UGM
 Johan Kurnianda – Med.Onc/UGM  Lifu Hu – KI, Swedia
 Henry Kusumo – RadiDiag/UGM  Susana Hutajulu – Biomol, UGM
 Salugu Maesadji – Radiother/UGM  Jajah Fachiroch MSc – Biomol/UGM
 Harijadi – PA/UGM  Dewi Paramita MSc– Biomol/UGM
 C. Murtono-PA/Atmajaya  Kuncoro cs – Dentist /RSS UGM
 Didik –PA/UGM  Sutarni cs – Neurology/RSS/UGM
 J.M. Middeldorp –VUmc/NL  Agus S Cs- Ophthalmo/UGM
 S.J.C. Stevens - AvL  IB Tjakra Wibawa-UNUD
 B. Tan- ENT/AvL  Widodo Ario Kencono-ENT/UNAIR
 Irawan Yusuf - UNHAS  Suhartati Gondowihardjo-
 Abdul Kadir – ENT/UNHAS Radiotherapy /UI
 Abdul Qadar - ENT/UNHAS  Marlindha Adam – UI
 Mardyah - USU  Demak L Tobing – Dharmais
 Hana Ratnawati-Maranatha  Cita Herawati- Dharmais
EBV – NPC Networking
 UGM  VUmc - NL
 UI  AvL - NL
 Dharmais  IGR – Fr
 UNHAS  KI – Sweden
 UNAIR  Umea - Sweden
 UNBRAW  QIMR – Austr
 UNUD  USM - Malaysia
 USU  Serawak
 Maranatha  IARC- Lyon
Research at EBV-NPC group
A. Development of diagnostic and prognostic markers
1. Protein level:
a. Immunohistochemistry
b. ELISAs
c. Immunoblotting
d. Immunofluorescence assay

2. DNA and RNA level: in whole blood and nasopharynx brush

B. Epidemiology study
1. Clinical (test serodiagnostic tools)
2. Field (aetiology of NPC)

C. Molecular genetic of NPC


DNA/RNA-EBV in NPC
Leukemia and lymphoma networking
From Bench to bedside

Sutaryo -UGM AJP Veerman –VUmc


Pudjo Hagung- UGM E. Tatsumi- Kobe Uni
Eddy Supriyadi -UGM
Kaiser Ali- Saskatoon,
Mulatsih –UGM
USA
Johan Kurnianda –UGM
Ibnu Purwanto-UGM UI
Mardiah Suci H-UGM UNSRAT
Kartika Widayanti-UGM
UNDIP
Arry Haryanto-Dharmais
UNAIR
Therapeutic cloning
 FM - GMU
Monash University
 VET MED GMU
 Animal Sc – GMU National Seoul
 UI University
 Dharmais
 UNDIP Chiba University
 UNHAS
Okayama
 UNAIR
 DLL Osaka
dll
Seminar Translational Research, From Basic to Clinic. Yogyakarta,4 Maret 2006.

Leukemia Limfoblastik Akut pada


Anak:

Pudjo Hagung Widjajanto

Hematologi-Onkologi Anak,
RS Dr. Sardjito/FK UGM, Yogyakarta
A Diagnosis, Therapy started
Clinically detectable Complete D Relapse
B Remission

Therapy stopped or
C
becomes ineffective

RISET JOGJA? E Patient cured


A : Imunofenotiping, Karyotiping, Polimorfisme GCR,
Uji resistensi, Aspek gizi
A-B: Respon awal terapi, Apoptosis
A-E: Protokol WK-ALL 2000, 2005; Compliance; Registrasi
Colon & Gastric Ca - Networking
 Prof. Suripto (UGM)  Kobe
 Dr.FX Ediati (UGM)  Nagoya
 Dr. Triwibawa (UGM)
 Osaka
 Dr. Aru Sudoyo, PhD (UI/
Dharmais)  UICC
 Prof. Irawan Yusuf ( UNHAS)  IARC
 UNDIP
 UNS
 Others
Let’s do it,
hand in hand