Genomic features of lung cancer patients in Indonesia's national cancer center.

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.

Factors Affecting 2-Year Survival in Patients With Non-Small Cell Lung Cancer Brain Metastases: Evidence from Indonesia's National Cancer Center, Jakarta, Indonesia.

Background: Brain metastases are a common complication in a wide range of cancers but are ubiquitous among patients with lung cancer. Limited data are available on the survival of patients with lung cancer and brain metastases in Indonesia. In this study, we aimed to identify the factors that might contribute to and predict survival in patients with non-small cell lung cancer (NSCLC) that resulted in brain metastases. Methods: This retrospective study on patients with NSCLC and brain metastases was conducted using data available from the medical records of the Dharmais National Cancer Hospital, Jakarta, Indonesia. The study outcome was survival time, which was associated with sex, age, smoking status, body mass index, number of brain metastases, tumor location, systemic therapy, and other therapies. Descriptive statistics, median survival, Kaplan-Meier graphs, and Cox regression were analyzed using SPSS version 27. Results: We included 111 patients with NSCLC and brain metastases in this study. The median patient age was 58 years. Long survivorship was observed among women (median: 95.4 weeks; P < .0003), patients with epidermal growth factor receptor (EGFR) mutations (median: 41.8 weeks; P < .0492), those who received chemotherapy (median: 58 weeks; P < .000), and those who received a combination of surgery and whole brain radiotherapy (WBRT; median: 64.7 weeks; P = .0174). Multivariate analysis showed consistent results for the following factors: sex, EGFR mutations, systemic therapy, and surgery plus WBRT. Conclusions: Female sex and EGFR mutations in patients with NSCLC and brain metastases are associated with a high survival rate. Patients who have NSCLC with brain metastases will benefit from treatment with EGFR tyrosine kinase inhibitors, chemotherapy, and surgery plus WBRT.

Overweight and Obesity are Associated with Poorer Survival Among Patients with Advanced Non-Small Cell Lung Cancer Receiving Platinum-Based Chemotherapy.

Background 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.

Repurposing FIB-4 index as a predictor of mortality in patients with hematological malignancies and COVID-19.

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) × âˆšALT (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.

Three Years Survival of Elderly Cancer Patients in Indonesia: Do We Need a Different Approach?

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.