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INDONESIA
Indonesian Journal of Cancer
Published by National Cancer Center-Dharmais Cancer Hospital
ISSN : 19783744     EISSN : 23556811     DOI : https://www.doi.org/ 10.33371
Core Subject : Health, Science,
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health
Indonesian Journal of Cancer is a peer-reviewed and open-access journal. This journal is published quarterly (in March, June, September, and December) by Dharmais Cancer Hospital - National Cancer Center. Submissions are reviewed under a broad scope of topics relevant to experimental and clinical cancer research. Articles are original research that needs to be disseminated and written in English. All submitted manuscripts will go through the double-blind peer review and editorial review before being granted acceptance for publication. The journal publishes original research articles, case reports, and review articles under the following categories: cancer management, cancer prevention, cancer etiology, epidemiology, molecular oncology, cancer diagnosis and therapy, tumor pathology, surgical oncology, medical oncology, radiation oncology, interventional radiology, as well as early detection.
Arjuna Subject : Kedokteran - Onkologi
Articles 658 Documents
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Chronic Myeloid Leukemia with S348L Mutation: A Case Report: Chronic Myeloid Leukemia with S348L Mutation Niniek Wiendayanthi; Lyana Setiawan; Marthino Robinson
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1517

Abstract

Background: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by the BCR-ABL1 fusion gene, which leads to constitutive tyrosine kinase activity. Tyrosine kinase inhibitors (TKIs), such as imatinib, are the first-line therapy and have significantly improved patient outcomes. However, resistance can occur, often due to point mutations in the BCR-ABL1 kinase domain. The S348L mutation is a rare variant whose clinical significance remains unclear. While some mutations are associated with TKI resistance, the response to treatment may vary. This report presents a case of CML with a pre-treatment S348L mutation that showed an unexpectedly favorable response to imatinib, highlighting the importance of understanding the diverse clinical behavior of BCR-ABL1 mutations. Background: Chronic myeloid leukemia (CML) is driven by the BCR-ABL1 fusion gene and is primarily treated with tyrosine kinase inhibitors (TKIs). BCR-ABL1 kinase domain mutations may contribute to TKI resistance, but the clinical significance of rare variants such as S348L remains unclear. We report a CML case with a pre-treatment S348L mutation and a favorable response to imatinib. Case Presentation: A 47-year-old female presented with complaints of weakness and nausea for several days. Physical examination revealed pallor and splenomegaly. Laboratory tests showed anemia (Hb 7.6 g/dL), hyperleukocytosis (243.87 × 10³/μL), and thrombocytosis (1,168 × 10³/μL). Peripheral blood smear demonstrated a left shift with increased immature granulocytes, and bone marrow aspiration revealed hypercellularity, consistent with chronic phase chronic myeloid leukemia (CML). PCR-based sequencing of peripheral blood confirmed the S348L BCR-ABL1 kinase domain mutation before initiating therapy. The patient was treated with first-line imatinib (400 mg daily). After one year of treatment, she achieved a major molecular response (MR4.5), with a BCR-ABL1 transcript level of 0.0021% (International Scale), indicating an excellent therapeutic response despite the pre-existing mutation. Conclusion: Despite the pre-treatment S348L mutation, the patient achieved a deep molecular response to first-line imatinib. This case suggests that S348L does not invariably confer imatinib resistance and highlights the variable clinical significance of rare BCR-ABL1 mutations. Further studies are warranted to clarify their prognostic and therapeutic implications.
A Case Series of Liver Resection for Hepatocellular Carcinoma: Challenges of Implementing the Barcelona Clinic Liver Cancer Guideline: HCC Surgery Beyond BCLC Guideline Rudi Napitupulu; Christopher Christopher; Jovan Muliyanto; Kellyn Zenjaya; Nathanael Napitupulu
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1518

Abstract

Background: Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, the sixth most common neoplasm, and the third most common cause of cancer death. Because of the lack of screening for HCC, the findings when the patient first arrives are likely to be in the unresectable category according to the Barcelona Clinic Liver Cancer (BCLC) guideline. Several studies reported that liver resection is a potentially curative therapeutic option for HCC even for intermediate/advanced stage. Herein, we present three intermediate-stage HCC cases treated with liver resection beyond BCLC recommendations. Case Presentation: We report three cases of hepatocellular carcinoma (HCC), respectively at the age of 46, 60, and 70 years old, that were classified as unresectable according to the BCLC guideline. All the patients showed Child-Pugh B on preserved liver function. They also represent large tumors and multiple tumors, which are also responsible for being an unresectable criterion. We considered the limitations of therapeutic options, socioeconomic demographics, national health insurance, and the superior outcomes of liver resection from several studies. We tried to go beyond the limitations by choosing liver resection for the unresectable categories. Conclusion: The BCLC criteria for liver resection should be less stringent. Proper identification by a multidisciplinary team for surgical intervention provides the optimal option for extended survival for intermediate-stage HCC. The objective of the treatment is to enhance patient survival while preserving optimal quality of life.
The Role of Arylhydrocarbon Receptor (AhR) and Tripartite Motif 56 (TRIM56) as E3 Ubiquitin Ligases in Cancer Development: A Scoping Review: Role of AhR and TRIM56 in Cancer Yusel Mareta Pamela; Binar Asrining Dhiani
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1528

Abstract

Background: The ubiquitin system is one of the mechanisms that regulates cell function, signalling, and cancer cell growth. Ubiquitin involves the E3 ubiquitin ligase to help mark and degrade target proteins. Recent research has shown that tripartite motif-containing 56 (TRIM56), an E3 ubiquitin ligase, can modulate protein stability through a ubiquitination mechanism that contributes to the transformation and progression of cancer cells. Another protein that can act as an E3 ubiquitin ligase is the aryl hydrocarbon receptor (AhR), known to be involved in the development of various types of cancer through different molecular mechanisms. Although both have been reported to affect cancer growth, studies on the functional linkage between TRIM56 and AhR are limited. Therefore, this scoping review was conducted to focus on identifying the key concepts and analysing the knowledge gaps of the potential role of TRIM56 and AhR in cancer growth and their linkage. Thus, this review can serve as a reference for further research. Methods: This study was conducted through a literature review, using a combination of Boolean OR and AND operators to search the Scopus and PubMed databases from 2015 to 2025 with keywords ("ubiquitination" OR "ubiquitin ligase" OR "e3") AND TRIM56 OR AhR OR "arylhydrocarbon receptor" AND cancer. Result: The expression of TRIM56 and AhR can serve as biomarkers in several types of cancer. Both proteins have a dual role, either suppressing or promoting cell proliferation by mediating the degradation or modification of various target proteins, thereby influencing cancer progression. TRIM56 and AhR are expressed in multiple cancers and are involved in similar signalling pathways, including ubiquitin, STING, Toll-like Receptor, NF-kB, and Wnt signalling pathways. Conclusion: TRIM56 and AhR affect cancer cell proliferation within the same cancer type through the ubiquitin, STING, Toll-like receptor, NF-κB, and Wnt signalling pathways.
Utility of Systemic Immune-Inflammation Index and Karnofsky Performance Status in Evaluating Short-Term Clinical Outcomes after Whole-Brain Radiotherapy in Patients with Brain Metastases from Solid Tumors: Short-Term Clinical Outcomes in Brain Metastases Impi Belinda; Cep Juli; Adji Kusumadjati; Sofiati Dian; Ahmad Rizal Ganiem; Siti Aminah Sobana; Aih Cahyani
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1536

Abstract

Background: Brain metastases are the most common brain tumors in adults with solid cancers and are associated with poor outcomes. Whole brain radiotherapy (WBRT) is the standard treatment for patients with multiple brain lesions, but responses vary. Prognostic markers are essential to guide treatment decisions. This study specifically evaluated the utility of the Systemic Immune-inflammation Index (SII) and Karnofsky Performance Status (KPS) in predicting clinical outcomes after WBRT. The study introduces a novel approach by analyzing SII without using a predetermined cut-off, instead stratifying patients using the median SII value, which is more applicable in a cohort where all patients already have advanced metastatic disease. Methods: A retrospective cohort study was conducted on 33 patients with brain metastases from solid tumors who underwent WBRT at Dr. Hasan Sadikin General Hospital between January 2019 and January 2024. Data collected included demographics, primary tumor type, neurological symptoms, baseline SII, and baseline KPS. Mortality and functional status were assessed two months after WBRT. Comparisons between groups were performed using the independent t-test or Mann-Whitney U test for continuous variables, and the Chi-square or Fisher’s Exact test for categorical variables. Changes in KPS before and after WBRT were analyzed using the Wilcoxon signed-rank test. Results: Patients who died had significantly higher SII and lower baseline KPS (p < 0.001). Seizures and altered consciousness were strongly associated with 2-month mortality (p < 0.001), whereas headache was associated with lower KPS post-WBRT (p < 0.001). Functional status (KPS) significantly improved two months after WBRT (p = 0.030). Baseline demographic factors were not significantly associated with outcomes. Because all patients had advanced metastatic disease, no universal SII cut-off was clinically appropriate; instead, the median SII across the cohort provided a more meaningful way to distinguish high versus low inflammatory status. Conclusion: SII and KPS demonstrated strong prognostic value in predicting survival and functional outcomes after WBRT. The use of median-based SII categorization represents a practical and novel approach for real-world settings where a validated cut-off may not apply. Early identification of elevated SII and low KPS may help clinicians personalize treatment strategies for patients with brain metastases.
Lynch Syndrome in a Young Male Patient: A Rare Case Report with Diagnostic Considerations: Lynch Syndrome in a Young Male Achmad Deza Farista; Vidi Orba Busro; Suyata Suyata; Yenny Dian Andayani; Mediarty Syahrir; Norman Djamaludin; Erty Sundarita; Sarup Singh; Suly Auline
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1538

Abstract

Introduction: Lynch syndrome, (LS), or hereditary nonpolyposis colorectal cancer (HNPCC), is an autosomal dominant inherited cancer syndrome primarily caused by germline mutations in DNA mismatch repair (MMR) genes, particularly MLH1 and MSH2. These mutations cause microsatellite instability (MSI), a hallmark of LS-associated colorectal cancer. Despite its clinical significance, LS remains underdiagnosed, particularly in low-resource settings.  Case Presentation: A 36-year-old man presented with intermittent right upper abdominal pain, chronic diarrhea, and unintentional weight loss of 17 kg over three months. Colonoscopy revealed an ascending colon mass, while computed tomography showed a malignant lesion causing luminal narrowing and mesenteric fat infiltration. Histopathology confirmed high-grade mucinous adenocarcinoma. Immunohistochemistry showed loss of MLH1 and PMS2 expression with retained MSH2 and MSH6, indicating MMR deficiency and MSI-high status. A detailed pedigree identified six first- and second-degree relatives with colorectal cancer, fulfilling the Amsterdam II and revised Bethesda criteria for LS. The patient underwent right hemicolectomy followed by adjuvant FOLFOX chemotherapy. Immunotherapy could not be administered because of limited access despite its established benefit in MSI-high colorectal cancer. Conclusions: This case highlights the importance of integrating clinical presentation, family history, and molecular findings in diagnosing LS. MMR immunohistochemistry is a reliable and cost-effective screening method that supports MSI detection and guides genetic testing. Early diagnosis enables appropriate treatment and cascade screening of at-risk family members.  
Body Image in Breast Cancer Patients Following Mastectomy: A Pilot Study: Body Image in Breast Cancer Patients Widiyono Widiyono; Rantiningsih Sumarni; Muna Nafiah
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1555

Abstract

Background: Breast cancer is a chronic non-communicable disease with the highest number of patients in Indonesia. Mastectomy remains a commonly used treatment approach. Physical changes that occur in post-mastectomy patients can affect self-concept, especially body image. Body image disorders are a challenge for nurses because the impact of body image disorders is more likely to disturb the patient's psychological condition, which can reduce the patient's quality of life. The purpose of this study was to describe body image in post-mastectomy breast cancer patients.  Methods: We conducted a descriptive, cross-sectional pilot study to summarize baseline characteristics using prevalence and percentages. Ninety-eight post-mastectomy patients attending outpatient follow-up at an oncology polyclinic made up the sample. Body image was assessed using the Body Image Scale (BIS). Results: A total of 98 post-mastectomy breast cancer patients participated in this study, most of whom were in the late elderly age group (> 56 years, 35.7%), Muslim (84.7%), housewives (52.1%), and had received a combination of surgery and chemotherapy (74.5%). The majority were classified as stage 2 (47.9%) or stage 3 (44.8%) cancer, with an illness duration of less than 6 months (41.8%) in most cases, and were primarily accompanied by a husband or wife (73.4%). Regarding body image, the majority of respondents (84.6%) reported a moderate level, followed by high (6.1%), low (5.1%), very low (2.1%), and very high (2.1%) levels.  Conclusions: These findings suggest a need for targeted interventions addressing moderate-level body image concerns. Nurses and other health professionals could consider offering psychotherapy and complementary therapeutic approaches to support these patients.    
Comparing CARG-TT and CRASH Scores in Predicting Severe Myelotoxicity Among Older Adults with Advanced Solid Tumors: CRASH vs CARG-TT in Severe Myelotoxicity Nur Riviati; Nur Qodir; Ridzqie Dibyantari; Eddy Yuristo NS; Aisyah Wirdah; Michael Jonathan Tan
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1559

Abstract

Background: Older adults with advanced solid tumors are at heightened risk of chemotherapy-induced myelotoxicity, which can compromise treatment delivery and outcomes. Risk stratification tools such as the Cancer and Aging Research Group Chemotherapy Toxicity Tool (CARG-TT) and the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) exist, but their performance in Indonesia remains uncertain. A locally validated, accurate predictor is needed to guide treatment intensity, monitoring, and allocation of limited resources. This study evaluates and compares the predictive performance of CARG-TT and CRASH for severe myelotoxicity in Indonesian older adults with advanced solid tumors.  Methods: This study applied a retrospective cohort design involving 109 geriatric patients aged 60 years or older with stage III or IV solid tumors who received chemotherapy at Mohammad Hoesin General Hospital, Indonesia, between September 2022 and 2024. Pre-chemotherapy assessments were performed using CARG-TT and CRASH. Severe myelotoxicity was defined in accordance with the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, including grade 3 or higher anemia (hemoglobin <8 g/dL), leukopenia (leukocyte count <2000/mm³), neutropenia (absolute neutrophil count <1000/mm³) with or without febrile neutropenia, and/or thrombocytopenia (platelet count <50,000/mm³). Receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive performance of both scoring systems. Statistical analyses were conducted using SPSS version 26.0, with a p-value of < 0.05 considered statistically significant.  Results: Among the 109 patients analyzed (mean age: 67.2 years; 54.1% female), 81 (74.3%) experienced severe myelotoxicity during chemotherapy. The median CARG-TT and CRASH scores were 10 and 8, respectively. The ROC-AUC for CRASH was 0.726 (95% CI: 0.633–0.807), significantly outperforming CARG-TT, which had an AUC of 0.610 (95% CI: 0.511–0.702; p = 0.022). CRASH demonstrated superior sensitivity and specificity in identifying high-risk patients.  Conclusions: The CRASH score outperformed the CARG-TT in predicting severe myelotoxicity among older adults with advanced solid tumors receiving chemotherapy.  
Limitations and Challenges in Diagnosing Bilateral Breast Cancer in Indonesia: A Case Report : Bilateral Breast Cancer in Indonesia Devina Yudistiarta; Sri Retno Dwidanarti; Didik Setyo Haryanto; Ajeng Viska Icanervilia; Lina Choridah
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1563

Abstract

Introduction: Bilateral breast cancer (BBC) is relatively uncommon but increasingly detected due to advancements in imaging and preoperative screening. In Indonesia, where screening is limited and patient awareness is low, BBC poses unique diagnostic challenges. Case Presentation: We report the case of a 55-year-old woman diagnosed with synchronous bilateral breast cancer (sBBC). The patient initially presented with a left breast mass diagnosed as invasive ductal carcinoma (IDC) via core biopsy but deferred treatment. Eighteen months later, she re-presented with pain in the left breast. Imaging revealed bilateral lesions, and subsequent surgery showed invasive lobular carcinoma (ILC) in both breasts. Magnetic resonance imaging (MRI) was not performed due to limited facility availability. The patient underwent modified radical mastectomy (MRM) of the left breast and lumpectomy of the right breast. Postoperative ultrasound revealed a residual right breast lesion, but the patient declined further treatment due to financial and cultural reasons. Conclusions: This case highlights diagnostic limitations and systemic challenges in Indonesia, including lack of screening coverage, patient delay in seeking care, limited imaging modalities, and refusal of further therapy. Histopathological discrepancies between biopsy and surgical specimens also underscore diagnostic complexity. Addressing these systemic barriers is essential for improving outcomes of BBC in Indonesia.
Adapting the Capizzi-Methotrexate Protocol for T-LBL in a Lower-Middle-Income Country: A Case Report: Adapted C-MTX for T-LBL in an LMIC Charity Cesilia Tololiu; Stefanus Gunawan; Max F J Mantik; M Rahimi Bahar; Anjo J P Veerman
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1572

Abstract

Introduction: Treating pediatric T-cell lymphoblastic lymphoma (T-LBL) in lower-middle-income countries (LMICs) is challenging, as the standard high-dose methotrexate (HD-MTX) regimen is unsafe without therapeutic drug monitoring. This case report aims to describe the clinical implementation, feasibility, and safety outcomes of an adapted Capizzi-style methotrexate (C-MTX) protocol as a practical alternative in a resource-limited setting Case Presentation: We report a case in Indonesia with T-LBL who was treated with an adapted C-MTX-based regimen. The protocol was chosen due to the inability to perform serum methotrexate measurements. He achieved initial complete remission and tolerated the therapy well. However, he experienced a relapse shortly after treatment completion Conclusions: Our experience demonstrates that a modified Capizzi-style Methotrexate protocol is a valuable and effective therapeutic strategy for pediatric T-LBL in settings with limited resources. This approach offers a practical way to circumvent the risks of unmonitored HD-MTX and can improve the standard of care.
Comparative Analysis of Two HER2 Immunohistochemistry Scoring Methods in Breast Carcinoma: Implications for HER2-Low Classification: Reproducibility of HER2 IHC Scoring in Breast Carcinoma Citra Dewi; Sandria Sandria; Novasari Novasari
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1575

Abstract

Background: Breast cancer is one of the most common carcinomas worldwide and remains the leading cause of cancer-related death among women. A key biomarker used to guide treatment decisions in breast carcinoma is the expression of human epidermal growth factor receptor 2 (HER2). However, the assessment of HER2 expression through immunocytochemical staining can be highly subjective and inconsistent. This study aims to evaluate the accuracy and consistency of HER2 assessment using a slide scanner with a computer, with a microscope and digital camera as an additional device. Methods: This study analyzed 51 cases of breast carcinoma registered at Mohammad Hoesin Hospital Palembang during February 2023, focusing on HER2 expression using assessment standards according to ASCO/CAP 2023. The computer-assisted pathology interpretation (CPI) protocol utilizes two complementary modalities for assessing HER2 expression, including digital slide scanning with the Ventana DP200 system and manual microscopy using an Olympus CX21 microscope paired with an Indomicro digital camera. These methods were compared to assess consistency and accuracy in HER2 scoring. Data were analyzed using Cohen’s Kappa test and the McNemar test. Results: Statistical analysis using Cohen’s kappa test showed a moderate agreement rate between the two methods (κ = 0.434). McNemar’s test revealed a statistically significant difference in classification (χ² = 5.06; p = 0.024), with Method 1 (digital imaging system) identifying 17 HER2-positive cases (score 3+), identical to Method 2, but classifying a greater number of HER2-low cases (1+ and 2+). A total of 31 cases compared to 16 by Method 2. Conclusion: The digital scanner method demonstrated moderate agreement with manual microscopy, yet showed potential advantages in workflow efficiency and classification consistency. While it may aid in streamlining HER2 assessment, manual microscopy remains essential for verifying ambiguous or borderline cases where algorithmic interpretation may be limited. Integrating both methods can enhance diagnostic accuracy and support more informed therapeutic decision-making for breast cancer patients.

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