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 ??
RSK Dharmais
Depdiknas DepKes KMNRT
UI
UNPAD
UNDIP
UGM
UNAIR
UNHAS
USU dll
LIPI
BPPT
LAPAN
BATAN
Bakosurtanal
BMG
CoE
Cancer
hosp
LITBANGKESCoE
CoE
CoE
CoE
CoE
CoE
CoE
CoE
Eijkman
CoE
CoE
CoE
CoE
CoE
CoE
RS tipe A, B, C
Institusi
Visi dan Misi
SDM, Expertise
Prog. Unggulan
Infrastructure
Kolaborasi N/Intl
Penelitian tidak
repetitif
Synergi SDM,
fasilitas
Networking :
Info hasil penelit
SDM – Outsourcing
Fasilitas
Multicenter study
CoE
• Cancer Research
• Acuan ARN/Litbangkes
• Preventif
• Diagnostic/Prognostic
• Treatment
Hsl Penelitian
-Indonesia
publikasi,recognisi
-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
Kasus
Persentase
(%)
Tumor Payudara
Tumor Serviks
Tumor Kolorektal
Tumor Paru
Tumor Nasofaring
Tumor Hati
Limfoma
Leukemia
Tumor Tiroid
Tumor Ovarium
437/1348
254/1348
121/1348
113/1348
104/1348
76/1348
62/1348
62/1348
62/1348
57/1348
32,4
18,8
9
8,4
7,7
5,6
4,6
4,6
4,6
4,2
Data 10 Tumor Ganas Terbanyak
di RS Dr. Sardjito Yogyakarta Tahun 2004
Jenis Tumor Jumlah
Kasus
Persentase
(%)
Tumor Serviks
Tumor Payudara
Tumor Nasofaring
Tumor Kolorektal
Tumor Kulit
Tumor Limfonodi
Tumor Vesikaurinaria
Tumor Prostat
Tumor Ovarium
Tumor Tiroid
103/479
78/479
67/479
63/479
41/479
40/479
31/479
21/479
18/479
17/479
21
16
14
13
8,4
8,3
6,47
4,38
3,76
3,55
EPIDEMI-
LOGY
1. Risk
Factor
2. Etiology
3. Survei-
llance&
Incidence
4. Genetic
1. Diagnostic
a. Natural Product
b. Synthetic Products
c. Drug Formulation
d. Clinical Trial
3. Palliative
4. Rehabilitative
5. Psychology
PREVEN-
TIONMECHANISMDIAGNOSTICCURATIVE
1. Vaccine
2. Nutrition&
Supplement
4. Culture
2. Therapy
e. Cost Assessment
STUDIES ON CANCER
Biological
Target
Protein,RNA,
DNA
3. Environ-
ment
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:
•Teguh Aryandono – UGM
•Kunta Setiadji – UGM
•Lina Choridah – UGM
•Dewayani Purnomosari – UGM
•IB Tjakra Wibawa – UNUD
•Samuel Haryono – Dharmais Cancer Hospital
•Daniel Sampepayung – UNHAS
•Noorwati – Dharmais Cancer Hospital
•Aru Sudoyo-UI
Collaborator:
•Gerard pals – VUmc, NL
•Paul van Diest – Utrecht
•Hoekstra – RUG
Et al.
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
Dharmais Cancer
Hospital
Udayana University,
Sanglah Hospital
Hassanudin
University
Free University
Medical Center,
Amsterdam
Utrecht Medical
Center
University Medical
Center Groningen
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
B. Hariwiyanto - ENT/UGM
Indwiani Astuti – Biomol,UGM
Johan Kurnianda – Med.Onc/UGM
Henry Kusumo – RadiDiag/UGM
Salugu Maesadji – Radiother/UGM
Harijadi – PA/UGM
C. Murtono-PA/Atmajaya
Didik –PA/UGM
J.M. Middeldorp –VUmc/NL
S.J.C. Stevens - AvL
B. Tan- ENT/AvL
Irawan Yusuf - UNHAS
Abdul Kadir – ENT/UNHAS
Abdul Qadar - ENT/UNHAS
Mardyah - USU
Hana Ratnawati-Maranatha
Pierre Busson – IGR, Fr
Rina Susilowati –Histo - UGM
Dyah Wulan –Biomol UGM
Lifu Hu – KI, Swedia
Susana Hutajulu – Biomol, UGM
Jajah Fachiroch MSc – Biomol/UGM
Dewi Paramita MSc– Biomol/UGM
Kuncoro cs – Dentist /RSS UGM
Sutarni cs – Neurology/RSS/UGM
Agus S Cs- Ophthalmo/UGM
IB Tjakra Wibawa-UNUD
Widodo Ario Kencono-ENT/UNAIR
Suhartati Gondowihardjo-Radiotherapy /UI
Marlindha Adam – UI
Demak L Tobing – Dharmais
Cita Herawati- Dharmais
EBV – NPC Networking
UGM
UI
Dharmais
UNHAS
UNAIR
UNBRAW
UNUD
USU
Maranatha
VUmc - NL
AvL - NL
IGR – Fr
KI – Sweden
Umea - Sweden
QIMR – Austr
USM - Malaysia
Serawak
IARC- Lyon
Research at EBV-NPC group
A. Development of diagnostic and prognostic markers1. Protein level:
a. Immunohistochemistry
b. ELISAs
c. Immunoblotting
d. Immunofluorescence assay
2. DNA and RNA level: in whole blood and nasopharynx brush
B. Epidemiology study1. Clinical (test serodiagnostic tools)
2. Field (aetiology of NPC)
C. Molecular genetic of NPC
DNA/RNA-EBV in NPC
Leukemia and lymphoma networking
Sutaryo -UGM
Pudjo Hagung- UGM
Eddy Supriyadi -UGM
Mulatsih –UGM
Johan Kurnianda –UGM
Ibnu Purwanto-UGM
Mardiah Suci H-UGM
Kartika Widayanti-UGM
Arry Haryanto-Dharmais
AJP Veerman –VUmc
E. Tatsumi- Kobe Uni
Kaiser Ali- Saskatoon,
USA
UI
UNSRAT
UNDIP
UNAIR
From Bench to bedside
Therapeutic cloning
FM - GMU
VET MED GMU
Animal Sc – GMU
UI
Dharmais
UNDIP
UNHAS
UNAIR
DLL
Monash University
National Seoul
University
Chiba University
Okayama
Osaka
dll
Leukemia Limfoblastik Akut pada
Anak:
Pudjo Hagung Widjajanto
Hematologi-Onkologi Anak,
RS Dr. Sardjito/FK UGM, Yogyakarta
Seminar Translational Research, From Basic to Clinic. Yogyakarta,4 Maret 2006.
A : Imunofenotiping, Karyotiping, Polimorfisme GCR,
Uji resistensi, Aspek gizi
A-B: Respon awal terapi, Apoptosis
A-E: Protokol WK-ALL 2000, 2005; Compliance; Registrasi
BComplete
Remission
Patient curedE
C
D Relapse
Diagnosis, Therapy started
Clinically detectable
A
Therapy stopped or
becomes ineffective
RISET JOGJA?
Colon & Gastric Ca - Networking
Prof. Suripto (UGM)
Dr.FX Ediati (UGM)
Dr. Triwibawa (UGM)
Dr. Aru Sudoyo, PhD (UI/
Dharmais)
Prof. Irawan Yusuf ( UNHAS)
UNDIP
UNS
Others
Kobe
Nagoya
Osaka
UICC
IARC
Let’s do it,
hand in hand
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