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All Journal Medicinus : Jurnal Kedokteran Jurnal Health Sains Al Makki Health Informatics Journal
Putri, Hesti Andika
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Vaccine-Based Immunotherapy for Metastatic Colorectal Cancer: A Systematic Review Amelia, Sesa; Mathlubaa, Asya; Amly, Harzalina Zilfi; Jacobs, Christin Yosefin; Halim, Kurnia; Heriawan, Timotius Ivan; Guantoro, Vincent; Putri, Hesti Andika
Medicinus Vol. 14 No. 3 (2025): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v14i3.10166

Abstract

Background: Metastatic colorectal cancer (mCRC) remains a therapeutic challenge, particularly in microsatellite stable (MSS) tumors, which are largely unresponsive to current immunotherapy approaches. Vaccine-based immunotherapy offers a strategy to elicit tumor-specific immune responses in these immunologically “cold” tumors. However, clinical results have been mixed, and the efficacy and safety of cancer vaccines in mCRC remain to be clarified. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating vaccine-based immunotherapy in mCRC were identified from PubMed, EMBASE, and Scopus as of May 2, 2025. Eligible studies included human subjects with mCRC receiving vaccine therapy with or without additional treatments, compared to standard or placebo regimens. The primary outcomes were overall survival (OS) and progression-free survival (PFS); safety was assessed by the incidence of grade ≥3 treatment-related adverse events. Result: Five RCTs comprising 804 patients met inclusion criteria. Pooled analysis showed a trend toward improved OS with vaccine-based immunotherapy (HR 0.81; 95% CI, 0.65–1.00; p = 0.05; I² = 0%), and a modest, non-significant improvement in PFS (HR 0.80; 95% CI, 0.62–1.05; p = 0.07; I² = 0%). The incidence of severe adverse events was lower with vaccine-based therapies (RR 0.31; 95% CI, 0.02–6.09; p = 0.23; I² = 90%). Conclusions: Vaccine-based immunotherapy in mCRC demonstrates potential clinical benefit, particularly in prolonging survival with a favorable safety profile. Further biomarker-driven studies are needed to optimize patient selection and therapeutic combinations.
Persistent Hypoglycemia: A Rare Case Report Of Clinically Diagnosed Insulinoma Putri, Hesti Andika; Febryan, Reza
Jurnal Health Sains Vol. 6 No. 8 (2025): Journal Health Sains
Publisher : Syntax Corporation Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/jhs.v6i8.2676

Abstract

Insulinoma is a rare disease, with an incidence of approximately 4 cases per 1 million people per year. It is a pancreatic tumor that produces insulin and is classified as one of the functional pancreatic neuroendocrine tumors, originating from the pancreatic ductal cells. In insulinoma, insulin is produced abnormally and continuously, leading to persistent hypoglycemia due to excessive insulin levels. We report a case of a 49-year-old female patient who presented to the emergency department with a chief complaint of generalized weakness. The weakness was persistent and typically occurred before meals, improving after the consumption of sugar water. The patient also reported dizziness, cold sweats, blurred vision, and tremors. Laboratory tests revealed a random blood glucose level of 35 mg/dL, a fasting insulin level of 82.4 µIU/mL, and a C-peptide level of 1.07 ng/mL. Abdominal CT scan did not detect a pancreatic mass, and MRI findings were also inconclusive. Therefore, further evaluation with Endoscopic Ultrasound (EUS) and GLP-1R PET/CT was recommended. The diagnosis of insulinoma was made based on clinical and biochemical findings, fulfilling Whipple’s triad and the diagnostic criteria of blood glucose < 55 mg/dL, insulin ≥ 55 µIU/mL, and C-peptide ≥ 0.6 ng/mL. The therapeutic algorithm for clinically and biochemically confirmed insulinoma includes: stabilization of hypoglycemia, evaluation of tumor resectability, and administration of medical therapies such as everolimus, peptide receptor radionuclide therapy (PRRT) with Lu-177, chemotherapy, and local ablation techniques in cases of refractory disease.
HIV/AIDS Young Adult with Diabetes Mellitus Presenting with Newly Diagnosed Pulmonary Tuberculosis, Pneumonia Hypokalemia and Atrial Fibrillation : A Rare Case Report Putri, Hesti Andika; Febryan, Reza
Al Makki Health Informatics Journal Vol. 3 No. 4 (2025): Al Makki Health Informatics Journal
Publisher : Al Makki Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57185/hij.v3i4.57

Abstract

Pneumonia, pulmonary tuberculosis (TB), Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), and metabolic disorders such as diabetes mellitus (DM) represent complex clinical challenges, particularly in young adults. Hypokalemia and cardiac arrhythmias such as atrial fibrillation (AF) may further worsen the prognosis in these conditions. Recent studies have highlighted the association between TB, pneumonia, and AF, suggesting an increased risk of systemic inflammation and electrolyte disturbances. We report and analyze a rare case of a young male patient with a unique combination of HIV infection, diabetes mellitus, clinical pulmonary TB, pneumonia, hypokalemia, and atrial fibrillation. This is a descriptive case report study. Data were collected through history taking, physical examination, supporting investigations, and management during hospitalization. A 25-year-old male presented with shortness of breath for one day, a history of cough for more than three months, weight loss, fever, and a history of insulin use five years prior. Physical examination revealed pale conjunctiva and oral candidiasis; no other abnormalities were found. Laboratory tests showed hemoglobin 10.8 g/dL, leukocytes 8,280/µL, platelets 296,000/µL, MCV 89.4 fL, MCHC 33.9 g/dL, HbA1c 8.4%, potassium 2.7 mmol/L, lymphocytes 6.6%, and reactive results for HIV qualitative testing (R1, R2, R3). Electrocardiogram (ECG) showed atrial fibrillation with normal ventricular response. Chest X-ray revealed normal cardiac size and findings suggestive of bronchitis and suspected pneumonia. Thoracic CT scan with and without contrast demonstrated features consistent with pneumonia and multiple bilateral paratracheal and subcarinal lymphadenopathy. This case highlights the need for multidisciplinary management involving anesthesiology, pulmonology, internal medicine, cardiology, and pharmacy to ensure comprehensive care and optimize clinical outcomes, while preventing potentially fatal complications.
Co-Authors Amelia, Sesa Amly, Harzalina Zilfi Febryan, Reza Guantoro, Vincent Halim, Kurnia Heriawan, Timotius Ivan Jacobs, Christin Yosefin Mathlubaa, Asya