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