Research And Development

at
“Dharmais” Cancer Center Hospital
(National Cancer Center)
A new Paradigm for National
Cancer Control Program in
Indonesia

Research and Development Symp Nov 2010 1

 Cancer Control Facts in Indonesia
Strength
Sub-directorate in Ministry of health (2006)
National Cancer Hospital (1993)
Weakness
No National Control Programs
National Cancer Registry is still under way

National Cancer Center

Research and Development Symp Nov 2010 2
Plan of Regional Cancer Center Indonesia

Regional Cancer Centre

National Cancer Centre
Research and Development Symp Nov 2010 3
Type of Cancer Center

Research and Development Symp Nov 2010 4

Dharmais National Cancer Hospital

I. Cancer Research Center (2012)

II.Comprehensive Cancer
Center(2014)
Research and Development Symp Nov 2010 5
Concept of Cancer Control
Program
Incidence ↓ Mortality ↓ Survival ↑

Primary Early Detection

Cancer
Prevention
Control
Program
Quality
of Life

Supportive &
Palliative care Diagnosis & Treatment

Capacity Education & Public Campaign

Building Cancer Registry &
Resources
Surveillance

Understand cancer Develop diagnosis & Provide evidence for

biology/pathology treatment policy-makers

ResearchBasic (Cohort) / Translational

Research and Development / Clinical / Policy
Symp Nov 2010 6
 Vision and Mission of Dharmais
Cancer Center Hospital
 Vision:
 Toward National Cancer Control program based on
evidence based by Cancer research and registry.

 Mision :
 To conduct basic research in cancer
 To conduct pre-clinic and clinical research improving
treatment, diagnostic and cancer prevention.
 Hospital based and community based cancer registry.

Research and Development Symp Nov 2010 7

Scope of R-D in Dharmais Cancer
Hospital

 Molecular biology Lab

 Clinical Trial
 Cancer Registry

Research and Development Symp Nov 2010 8

 Function of Dharmais Cancer
Hospital

 Leader, Reference, Bench-mark for

National Cancer Hospital, and
National Cancer Center

Research and Development Symp Nov 2010 9

 Focus of Cancer Research,
should be:
 Research based on clinical or community
problems  back to clinical or community
benefit
 Integrated and multi discipline research
team
 Impact to decision making on early
detection, cancer prevention , diagnosis,
and treatment
Research and Development Symp Nov 2010 10
Some research, past and
on going

Research and Development Symp Nov 2010 11

Scope of R-D in Dharmais Cancer
Hospital

 Molecular biology Lab

 Clinical Trial
 Cancer Registry

Research and Development Symp Nov 2010 12

 Pathogenesis

Epigenetic changes in Breast Cancer

1. Hypermethylation in ER Gene ER
negative
2. Methylation in HME-1 (G2-check
point in cell cycle)
3. Methylation in Tumor Supressor
Gene
4. Methylation in WRN Gene
Research and Development Symp Nov 2010 13
 Risk Factor
1. Epidemiological study (hospital
and population based) in
cervical cancer, and breast
cancer
2. Genetic study
• Familial breast cancer
• Polymorphism in nitrosamine
metabolism gene
3. Epigenetic study methylation
and metabolism of nutrition
Research and Development Symp Nov 2010 14
 Diagnosis
1. Genetic study in breast
cancerdiagnose basal like breast
cancer by DNA expression microarray
2. Genetic studyDNA EBV LMP2 Cut off
point in NPC

Research and Development Symp Nov 2010 15

 Therapy
 Stem cell Therapy for hematology
cancer after ablative chemotherapy
 Bone marrow and stromal bone marrow
 Mobilized peripheral blood

 Cell line study Potency of herbal

medicine in cancer cell

Research and Development Symp Nov 2010 16

 Therapy responses
Genetic study
1. Polymorphism in CYP2B6 gene and
relationship with cyclophosphamide
pharmacokinetic
2. P53 and K-Ras mutation in colorectal

Research and Development Symp Nov 2010 17

 Survival
 Epidemiology study survival among
breast cancer and LNH patients
 Survival rate in relation with ER status and
among BLBC

Research and Development Symp Nov 2010 18

 Prognostic
 LMP-1 and LMP-2 in NPC
 Cytokine response in colorectal cancer
and lung cancer
 K167 in basalioma as a proliferation
marker

Research and Development Symp Nov 2010 19

 Supportive
 THL in NPC
 Nutrican in Head and Neck Ca

Research and Development Symp Nov 2010 20

Scope of R-D in Dharmais Cancer
Hospital

 Molecular biology Lab

 Clinical Trial
 Cancer Registry

Research and Development Symp Nov 2010 21

 Clinical trial
 Multi Center CT : 12 trials
 Pharmacy sponsored : 10 trials
 Investigator innitiated study : 2 trials (2 of
these trials collaborate with National
Cancer Center of several countries)
 Initiation phase : 3 trials

Research and Development Symp Nov 2010 22

R word of academic medicine was

Research

Research and Development Symp Nov 2010 23

R word of academic medicine is

RVU

Research and Development Symp Nov 2010 24

Scope of R-D in Dharmais Cancer
Hospital

 Molecular biology Lab

 Clinical Trial
 Cancer Registry

Research and Development Symp Nov 2010 25

 Cancer registry in Dharmais
 Human resources :
 Registrar : 10 bachelor of public health
 Verificator : 2 medical doctor
 Validator : 1 pathologist
 Facility :
 Cancer registry room
 Software canreg-4
 Computer
 Server

Research and Development Symp Nov 2010 26

 Progress Report
Cancer Registry “(hospital)
Population-Based”

Research and Development Symp Nov 2010 27

 ALUR KERJA SESUAI KEPMENKES No : 1068/Menkes/SK/XI/2008

RS Regional
6 RS Lokal
Jakarta Utara
Jakarta Utara
(RSUD Koja)
DirJen
RS Regional P2PL
10 RS Lokal
Jakarta Pusat
Jakarta Pusat
(RSPAD)

RS Regional Pusat
5 RS Lokal
Jakarta Barat DirJen
Jakarta Barat Data Kanker
(RSKD)
Nasional BinYanMed

RS Regional
11 RS Lokal
Jakarta Timur
Jakarta Timur Memvalidasi seluruh data
(RS Persahabatan) dari 5 Regional dan PusDatIn
Melaporkan ke DirJen
P2PL, DirJenBinYanMed, Depkes
PusDatIn Depkes
RS Regional
8 RS Lokal Sifat kegiatan Registrasi Kanker :
Jakarta Selatan
Jakarta Selatan
• Reg.Kanker Aktif :
(RS Fatmawati)
membentuk tim RS lokal dan RS Regional mengirimkan
registrasi Memvalidasi data ke Pusat Data Kanker Nasional
kanker, data kanker RS
melakasanakan di wilayah • Reg.Kanker Pasif :
reg.kanker dan Regionalnya dan Pusat Data Kanker mengumpulkan dan
melaporkan ke melaporkan ke
Pusat Data Research and menjemput
Development data
Sympke RS
Nov Lokal dan RS
2010 28
RS regional
Kanker Nasional Regional
 Source of Data

90 Laboratories
2 Clinics

Central National Data

of Cancer Vital Statistics
Death Certificates
79 Hospitals

301 Primary 44 Municipals

Health Research Health
Care and Development Care
Symp Nov 2010 29
 Jakarta Minimum Cancer Incidence (Coverage 70% )
79 Hospitals. 2 Private Clinics, 90 Pathology Laboratories,
44 Municipals Primary health Care (as a coordinator of 301
Primary Health Care in District area).

Research and Development Symp Nov 2010 30

Research and Development Symp Nov 2010 31
LET’S THINK

Research and Development Symp Nov 2010 32

 Aim of research study as
Cancer Hospital
 Diagnostic
 Treatment
 Prognostic
 Dharmais Hospital Ca Registry 
surveillance, provide feedback on
performance
Better Outcome

Research and Development Symp Nov 2010 33

 Aim of research study as National
Cancer Center,

 Prevention:
 Risk Factors
 Etiology
 Diagnostic
 Treatment
 Prognostic and every level of action across all
disease spectrum
 National Cancer Registry (hospital & pop)
Prevention to Treatment
Research and Development Symp Nov 2010 34
 Cancer Registry

Provides data:
 Incidence
 Prevalence
 Survival
 Density of cancer diseases in particular area

Research and Development Symp Nov 2010 35

Dharmais Hospital Cancer Registry
 Need to be established
 Indicator of Treatment Outcome:
 Survival: over-all & stratified, disease free, etc
 Obstacles:
 Medical records  incomplete
 Access to medical records
 Loss to follow up  needs networking

Research and Development Symp Nov 2010 36

 Planning for the future
 Focusing on hospital level
 Strengthen the systems; cancer
registry, clinical trial, bio-molecular
research
Man power, Funding
Policy and political position
Networking

Research and Development Symp Nov 2010 37

 Planning for the future
 Focusing on National Cancer Center
 Strengthen the systems: National
Cancer Control Program, National
Cancer Registry, Develop National
Guidelines/Recommendation, National
Research center (clinical trial, bio-
molecular, epidemiology research)
 Man power, Funding
 Policy and political position
 Networking

Research and Development Symp Nov 2010 38

 Research Area
 Cancer pathology
 Ca Pathofisiology
 Immune genetic
 Proteomic
 Herbal medicine for cancer treatment
 Research :
 Epidemiology  clinical and molecular (1. risk factors:
molecular, genetic, socio-biology; 2. clinical:
diagnostic, treatment, prognostic)
 Clinical trial  applied (screening, diagnostic,
treatment)

Research and Development Symp Nov 2010 39

 Institutional Review Board

Patient safety

Improving Protection for Research Subjects

Robert Steinbrook, M.D. Volume 346:1425-1430 May 2, 2002
New England Journal of Medicine
Research and Development Symp Nov 2010 40
NCI National Clinical Trials System

Data &
specimens
available for High Rapid Central Standard
Investigator Priority Central
discovery Protocol Patient Tools for Patients
Community Trials IRB
and Creation Enrollment Trial Conduct
development

NCI-supported clinical trial

Cooperative Groups & networks
and national tumor banks

Research and Development Symp Nov 2010 41

 Execution of Clinical Trial
 Patient recruitment
 Follow the protocol
 Be scientific and objective
 Maintain a highly ethical approach

Research and Development Symp Nov 2010 42

Research RVU
Research and Development Symp Nov 2010 43
 Focus on Disease Topics for
Research Development
1. Breast Cancer
2. Gynecological Cancer
3. Hematology Cancer Strategic Planning
4. Nasopharingeal Cancer
5. Lung Cancer
6. Colorectal Cancer
7. Skin Cancer
8. Cancer Stem Cell

Research and Development Symp Nov 2010 44

One Voice …

“No one can whistle a symphony…

you need a team to make that kind
of music!”

Research and Development Symp Nov 2010 45

 Thank You

Bambang Dwipoyono
Medical Staff Gyne-onco
Acting, Head of R&D Dharmais
Cancer Hospital
Research and Development Symp Nov 2010 46