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All Journal HAYATI Journal of Biosciences Indonesian Journal of Cancer Universa Medicina Jurnal Respirologi Indonesia Jurnal Ilmu Kefarmasian Indonesia Jurnal Respirasi (JR) Sumatera Medical Journal JURNAL PENELITIAN KEPERAWATAN MEDIK Respiratory Science Cermin Dunia Kedokteran Indonesian Journal of Cancer eJournal Kedokteran Indonesia
Elisna Syahruddin
Department Of Pulmonology And Respiratory Medicine, Faculty Of Medicine, Universitas Indonesia
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Earth & Planetary Sciences Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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National Lung Cancer Screening: Recommended Age for Screening Ramadhaniah, Fariha; Suzanna, Evlina; Syahruddin, Elisna; Shalmont, Grace; Rahayu, Pradnya Sri
Indonesian Journal of Cancer Vol 18, No 4 (2024): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i4.1223

Abstract

Indonesia, as a developing country, faces a significant burden of lung cancer, with the incidence and mortality rates ranking third. Unfortunately, the majority of patients are diagnosed at advanced stages of the disease. Indonesia has implemented a national cancer control program; screening and early detection are part of this program, which needs firm criteria to restrict the high-risk population due to limited resources. This article aims to recommend age criteria for National Lung Cancer Screening based on cancer registry data. We explore lung cancer screening policies across various countries, discuss the extent of the lung cancer burden and smoking prevalence as factors in determining age criteria for screening. Lung cancer is coded using ICD-O, third edition, C33–C34, and the incidence data were obtained from the Jakarta cancer registry. Data on the prevalence of smoking were obtained from national surveys and other research. Our review suggests that lung cancer screening should start at 35 years old, considering the distribution of lung cancer, the prevalence of smoking in Indonesia, as well as the carcinogenesis process of an individual when they start smoking.
Post-Market in vitro bioequivalence study of innovator and generic Gefitinib tablets: evaluation of JKN medicine quality Nurhayati, Fitri; Anggriani, Yusi; Syahruddin, Elisna; Andalucia, Rizka; Ath-Thobari, Jarir; Mulatsari, Esti
JURNAL ILMU KEFARMASIAN INDONESIA Vol 22 No 1 (2024): JIFI
Publisher : Faculty of Pharmacy, Universitas Pancasila

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35814/jifi.v22i1.1593

Abstract

Gefitinib is one of Tyrosine Kinase Inhibitors (TKIs), as first line therapy for Non-Small Cell Lung Cancer (NSCLC) with positive EGFR mutation. Gefitinib started to be accommodated in Jaminan Kesehatan Nasional (JKN) insurance in 2015 with the innovator gefitinib and was replaced by a generic product in middle of 2021. This research was conducted to see whether the quality of generic gefitinib equivalent to the innovator through post-market in vitro bioequivalence test. Assay method refers to previous research by Sandhya et al 2013 wih High Performance Liquid Chromatography (HPLC), while the dissolution test method is in accordance with the Food and Drug Association (FDA) 2010. We collected innovator from the official distributor and 3 batches (all batches that have been used in JKN program) of generic product from hospitals where lung cancer therapy services were provided. We evaluated the dissolution profile with similarity and unsimilarity factors and assess based on standard specification of dissolution profile that informed in innovator’s BPOM-approved brochure (avarage of 6 samples > 85% and no individual result < 75% at 45 minutes). The assay results met the requirements of ± 5% of what is stated on the label. Although dissolution profile of generic and innovator were not equal through difference and similarity factors calculation, but one batch of generics met dissolution profile standard of innovator. So, both generic and innovator drug met the standards of assay and dissolution, even though the dissolution profile were not equivalent.
ALK and PD-L1 Expression in Non-Small Cell Lung Cancer through Immunohistochemical Assays in Indonesia Syahruddin, Elisna; Sayekti, Mutia A.; Yuliyanti, Sayekti; Thabrany, Hasbullah; Nurmadani, Labbaika
Jurnal Respirologi Indonesia Vol 45 No 3 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v45i3.794

Abstract

Background: Advanced therapies for non-small cell lung carcinoma (NSCLC), such as targeted therapy and immunotherapy, are available; however, their use depends on biomolecular testing. In the Indonesian context, EGFR testing is covered by the national health insurance (JKN). According to the Indonesian Clinical Guideline for Lung Cancer, if the EGFR test is negative, further testing, including ALK and PD-L1 immunohistochemistry, is required. Nevertheless, the JKN does not currently cover ALK and PD-L1 IHC tests, which restricts access to the appropriate therapies. This study aims to determine the positivity rates of ALK and PD-L1 IHC tests. Method: This study employs a cross-sectional approach to analyze 2,553 ALK and PD-L1 IHC tests conducted from 2019 to 2023, sourced from four major provinces in Indonesia Results: The positivity of ALK IHC tests is 8% with a median age of 52 years. The positivity rate for PD-L1 IHC in all patients is 49%, while based on the tumour proportion score (TPS), TPS ≥50% is 17% and TPS 1-49% is 32%. ALK positivity correlates with age and female gender (P<0.001 and P=0.006). Conversely, PD-L1 positivity was significantly associated with cancer type (P=0.008). Conclusion: ALK positivity in NSCLC in Indonesia is relatively high (8%), with a relatively young median age of 52 years and is predominantly found in females. PD-L1 positivity does not significantly differ by gender and age, but positively correlates with adenocarcinoma cancer type.
Risk Factors for Lung Cancer in Non-smoking Women, North Sumatera, Indonesia Buana, Indra; Soeroso, Noni Novisari; Tarigan, Setia Putra; Syahruddin, Elisna
Sumatera Medical Journal Vol. 8 No. 1 (2025): Sumatera Medical Journal (SUMEJ)
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/sumej.v8i1.18763

Abstract

Background: Basic Health Research Data in 2018 reported that lung cancer in women in Indonesia ranked third after breast cancer. A person's risk of developing lung cancer can be evaluated by looking at age, genetic predisposition, tobacco use, and exposure to toxic agents. Objective: To obtain data on several risk factors associated with the incidence of lung cancer in non-smoking women at Adam Malik General Hospital and Santa Elisabeth General Hospital. Methods: This case-control matching study involved 224 research subjects through medical record data collection from January 2019 to December 2020. All subjects were confirmed by questionnaires related to risk factors: age, exposure to cigarette smoke (passive smokers), genetics, exposure to firewood, and air pollution. Data were analyzed by logistic regression test. Results: The average age in the case group was 57.86 years; in the control group, 47.4 years. Five risk factors influenced lung cancer incidence: age (p = 0.008), passive smokers (p = 0.043), genetic factors (p < 0.001), exposure to firewood (p = 0.007), and air pollution (p = 0.041). Conclusion: Risk factors that significantly influence lung cancer incidence in non-smoking women are age over 40 years, genetic factors, passive smoking, and exposure to firewood.
The Time to Progression in Lung Adenocarcinoma Patients Receiving First- and Second-Generation EGFR-TKI in Indonesia Syahruddin, Elisna; Soeroso, Noni Novisari; Ananda, Fannie Rizki; Wulandari, Laksmi; Setijadi, Ana Rima; Ermayanti, Sabrina; Pratiwi, Suryanti Dwi; Infianto, Andreas; Andayani, Novita; Munir, Sri Melati; Pratama, Avissena Dutha; Kusumawardani, Ida Ayu Jasminarti Dwi; Haryati, Haryati; Duyen, Natalie; Hanif, Muhammad Alfin; Lim, Darren Wan-Teck
Jurnal Respirasi Vol. 11 No. 1 (2025): January 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.1.2025.22-30

Abstract

Introduction: Targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), is the first-line treatment for non-small cell lung cancer (NSCLC). However, drug resistance has grown in the last few decades. This study compared the progression time of lung cancer patients treated with first- and second-generation EGFR-TKI. Methods: Based on cytology and histological results, this cross-sectional study included 1,008 participants diagnosed with lung adenocarcinoma (LUAD) from 11 Indonesian Respiratory Centers. Every three months, the response to treatment was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) criteria in 1.1. Significant differences in the clinical features of the three TKI treatment groups were identified using logistic regression analysis, the median time to disease progression was estimated using the Kaplan-Meier technique, and independent prognostic factors related to the time to progression (TTP) were assessed using Cox proportional hazards regression. Results: This study examined 505 patients, the majority of whom were females (50.9%), never smoked (59.8%), diagnosed at an advanced stage (99.2%), and had an Eastern Cooperative Oncology Group (ECOG) scale of 0-1 (83.2%). Approximately 98.1% of patients were treated with afatinib (14.8%), erlotinib (18.6%), and gefitinib (66.1%) due to common mutations. The groups did not differ significantly (p>0.05). The median overall survival (OS) rate was 9 months. The time to LUAD progression in lung cancer was significantly impacted by poor performance (p=0.001). Conclusion: Epidermal growth factor receptor-tyrosine kinase inhibitor treatment can only prolong the TTP of LUAD by up to 9 months, and the performance scale when receiving the EGFR-TKI significantly affects the prognosis.
Anaplastic Lymphoma Kinase (ALK) Rearrangement of Lung Adenocarcinoma among North Sumatera Population Putra, Muhammad Yusuf Adira; Soeroso, Noni Novisari; Syahruddin, Elisna; Suzanna, Evlina; Afiani, Dina; Ashar, Taufik; Lim, Darren Wan-Teck
Jurnal Respirasi Vol. 11 No. 1 (2025): January 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.1.2025.47-53

Abstract

Introduction: Lung cancer is a malignancy of the lung parenchyma or bronchi. Molecular targeted therapy directed at oncogene driver mutations, such as anaplastic lymphoma kinase (ALK), improves the prognosis of patients with non-small cell lung carcinoma (NSCLC). This study aimed to determine the characteristics of lung adenocarcinoma patients and the prevalence of ALK rearrangement among the North Sumatra population. Methods: This descriptive study used data from patients' formalin-fixed paraffin-embedded (FFPE) ALK examination results and medical records. The laboratory analyzed the patient’s FFPE for ALK fusion protein expression using the VENTANA anti-ALK (D5F3) procedure to determine the prevalence of ALK rearrangement. Results: Of the 34 subjects, it was revealed that the characteristics of lung adenocarcinoma patients were 18 patients aged >60 years old (52.9%), 26 male patients (76.4%), and 24 heavy smoker patients (70.6%). Based on the pathological tumor-node-metastasis (pTNM) stage, most samples were classified as stage IVA, with 24 cases (70.6%) showing the highest metastases to the pleura. There were 2 cases of ALK mutations obtained through immunohistochemical examination with a percentage of 5.8%. Conclusion: There are relatively few ALK rearrangement mutations in lung adenocarcinoma patients without screening. Additional research is needed to ascertain the distribution of lung adenocarcinoma patient characteristics associated with a higher prevalence of ALK rearrangement mutations.
Diagnosis and Management for Pulmonary Tuberculoma Syahruddin, Elisna; Burhan, Erlina; Saputra, Tetra Arya
Respiratory Science Vol. 4 No. 2 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i2.107

Abstract

Pulmonary tuberculoma, prevalent particularly in tuberculosis (TB)-endemic regions, often appears as a solitary nodule of less than 30 mm, or a tumor of more than 30 mm on radiological examinations. It may also present with a combination of abnormalities, such as multiple nodules with infiltration or pleuritis. Benign solitary pulmonary nodules represent up to 25% of all resected solitary pulmonary nodules, with approximately 5-24% of these identified as pulmonary tuberculoma post-surgery. This condition is prevalent particularly in TB-endemic regions, and must be considered while determining the diagnosis, especially for patients at high risk for lung cancer. Modalities for diagnosing pulmonary tuberculoma include chest radiography, USG, CT scan, PET scan and bronchoscopy with transbronchial biopsy. The treatments for pulmonary tuberculoma are anti-TB drugs and surgery. Pulmonary tuberculoma responds poorly to anti-TB drugs and requires long-term treatment. Surgery is performed when the diameter of tuberculoma still increases after adequate anti-TB treatment.
Indonesian Society of Respirology Position Paper on Lung Cancer Control in Indonesia Andarini, Sita; Santoso, Andintia Aisyah; Arfiansyah, Mochammad Aris; Syahruddin, Elisna; Zaini, Jamal; Putra, Andika Chandra; Kurniawan, Ferry Dwi; Ermayanti, Sabrina; Soeroso, Noni Novisari; Munir, Sri Melati; Infianto, Andreas; Setijadi, Ana Rima; Setyawan, Ungky Agus; Wulandari, Laksmi; Haryati, Haryati; Jasminarti, Ida Ayu; Hidayat, Moulid; Santoso, Arif
Jurnal Respirologi Indonesia Vol 44 No 4 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i4.884

Abstract

Lung cancer is a major health concern in Indonesia due to its increasing prevalence, late-stage diagnosis, younger population, and high mortality. Addressing this issue requires nationwide implementation of comprehensive lung cancer control, which includes risk reduction and prevention strategies, focusing on tobacco control and air pollution mitigation. Screening with low-dose computed tomography (LDCT) and early detection in symptomatic patients, along with TB screening programs and all non-communicable diseases, is strongly recommended to enhance early case findings, treatment effectiveness, and overall patient outcomes. A multidisciplinary team (MDT) approach is important to ensure accurate diagnosis and comprehensive care. Moreover, the integration of palliative care at the early stages of advanced lung cancer is vital, focusing on symptom management and enhancing the quality of life for patients. While national guidelines are available for the diagnosis and treatment of lung cancer, significant disparities in healthcare access remain across Indonesia. Thus, it is essential to improve universal health coverage and referral systems to guarantee equal access to lung cancer care for patients at all levels through advocacy and ease of access.
Co-Authors Abul A'la Al Maududi Afiani, Dina AHMAD HUDOYO Ahmad Hudoyo Ahmad Hudoyo Aldri Frinaldi Alma Thahir Pulungan Ana Rima Ana Rima Setijadi Ananda, Fannie Rizki Andalucia, Rizka Andarini, Sita Andi Yasmon Andreas Infianto Anna Rozaliyani Annisa Dian Harlivasari Anwar Jusuf Anwar Jusuf Arfiansyah, Mochammad Aris Aria Kekalih Arif Faisal ARIF R HANAFI ARIF R HANAFI, ARIF R Arif Santoso Arif Santoso Ath-Thobari, Jarir AZIZA G ICKSAN AZIZA G ICKSAN, AZIZA G Aziza Icksan Aziza Icksan Buana, Indra Budiman Bela Denny Grecius Siregar Dian Cahyadi Dian Yulianti Duyen, Natalie Erlina Burhan Ermayanti, Sabrina Ermayanti, Sabrina Erni Mudhiati EVLINA SUZANNA, EVLINA Fariz, Nurwidya Feni Fitriani Fera Ibrahim Ferry Dwi Kurniawan Findra Setianingrum Fitri Nurhayati GRACE SHALMONT, GRACE Hanif, Muhammad Alfin Haryati Haryati Haryati Haryati Hasbullah Thabrany Heriawaty Hidajat Heriawaty Hidajat, Heriawaty Hidayat, Moulid Ida Ayu Jasminarti Ida Ayu Jasminarti Dwi Kusumawardani Infianto, Andreas Jasminarti, Ida Ayu Kurniawan, Ferry Dwi Laksmi Wulandari Lia G. Partakusuma Lim, Darren Wan-Teck Lisnawati Lisnawati Melva Louisa Mia Elhidsi Mulatsari, Esti Mulyati Tugiran Nathaniel Aditya Noni Novisari Soeroso Novita Andayani, Novita Nurmadani, Labbaika PRADNYA SRI RAHAYU, PRADNYA SRI Pratama, Avissena Dutha Pratiwi, Suryanti Dwi Putra, Andika Chandra Putra, Muhammad Yusuf Adira Rahmat Hidayat Ramadhaniah, Fariha Rianyta Rianyta Ridhawati Sjam Rita Khairani Robiatul Adawiyah Romi Baginta Santoso, Andintia Aisyah Saputra, Tetra Arya Sarah Fitriani Sayekti, Mutia A. Setiaputra Setiaputra Setyawan, Ungky Agus Shanty R. Kusumawardani Sita Andarini Sita Andarini Sita Andarini Soehardiman, Dicky Solly Aryza Sri Melati Munir Sri Melati Munir Steven Jonathan Tamam Anugrah TAMSIL Tarigan, Setia Putra Taufik Ashar Tiara Aninditha Vivian Soetikno Wira Winardi Yayi DB Susanto Yopi Simargi Yopi Simargi, Yopi Yuliyanti, Sayekti Yusi Anggriani Zahrah Annisa Zaini, Jamal