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Journal : Folia Medica Indonesiana

CASE REPORT: MANAGEMENT OF PROGRESSIVE LUNG CANCER PATIENTS AFTER FIRST-LINE EGFR TYROSINE KINASE INHIBITOR THERAPY Sahrun, Sahrun; Wulandari, Laksmi
Folia Medica Indonesiana Vol 55, No 3 (2019): September
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/fmi.v55i3.15509

Abstract

Various tyrosine kinase inhibitor (TKI) drugs have been widely used as therapy for cancer that has EGFR mutations, or abnormal EGFR activation. However, patients who have a mutation in the gene that activates EGFR only benefit from EGFR-TKI therapy for less than one year, because after that resistance occurs. In the management of patients according to NCCN 2017, patients who experience progress after receiving TKI as the first-line therapy must undergo an examination to identify the presence of T790M mutation. If the T790M mutation is positive, the choice of therapy that needs to be provided is the third generation (Osimertinib). Many recent studies have proved the significance of the effectiveness and response of Osimertinib therapy in lung cancer with EGFR T790M mutation. We reported the management of a pulmonary adenocarcinoma patient with positive EGFR mutation who had received first-line EGFR TKI who had progressive disease and T790M mutation in Dr. Seotomo Hospital. The patient finally received Osimertinib through an Early Access Program with a therapeutic response that improved significantly.
LYMPHOCYTE-T TYPE TH1 AND TH2 ACTIVITY DIFFERENCE OF LUNG TISSUE ON Heligmosomoides polygyrus NEMATODE AND Mycobacterium tuberculosis SEQUENTIAL CO-INFECTION Wulandari, Laksmi; Amin, Muhammad; Soedarto, Soedarto; Soegiarto, Gatot
Folia Medica Indonesiana Vol 53, No 2 (2017): JUNE 2017
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (371.852 KB) | DOI: 10.20473/fmi.v53i2.6356

Abstract

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis that are often associated with uneffectiveness of the BCG vaccine and the high worm infection. The objective of this study was to determine the differences in the activity of Limfosit T type Th1 (IFN-g) and Th2 (IL-4) in lung tissue on Heligmosomoides polygyrus nematode and Mycobacterium tuberculosis sequential co-infection. This research using 49 mice were divide into 7 groups treated with infection by Mycobacterium tuberculose inhaled and Heligmosomoides polygyrus orally within 8 and 16 weeks. The levels of IFN-g in peripheral blood serum (89.929 + 3.533 pg/mL) resembles the pattern of the percentage of lymphocytes T CD4+ Th1 in lung tissue (3.246 + 0.519%) and peripheral blood (4.950 + 0.237%), while the levels IL-4 in the peripheral blood serum (20.782 + 4.043%) resembles the pattern of the percentage of lymphocytes T CD4+ Th2 in intestinal tissue (1.048 + 0.359%) and peripheral blood (1.196 + 0.557%). In conclusion, there is difference in the activity of lymphocytes T type Th1 and Th2 but it does not affect the immune response to Mycobacterium tuberculosis infection.
COMPARISON OF CHEMOTHERAPY RESPONSE AND ADVERSE EFFECTS OF DOUBLE-PLATINUM PLUS EGFR-TKI VERSUS DOUBLE-PLATINUM ALONE ON NSLCLC PATIENTS WITH DISEASE PROGRESSION AND EGFR-TKI TREATMENT Wulandari, Laksmi; Wiriansya, Edward Pandu
Folia Medica Indonesiana Vol 53, No 4 (2017): December 2017
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (157.199 KB) | DOI: 10.20473/fmi.v53i4.7161

Abstract

EGFR-TKI is the first-line therapy for EGFR-mutant patients. Nevertheless, patients will have disease progression (median PFS 10 – 12 months) due to resistance. The treatment options are still limited in developing countries for such cases, thus double-platinum chemotherapy is the next option. Although IMPRESS study reported no difference in terms of PFS and OS between double-platinum alone and double-platinum plus EGFR-TKI, several local studies reported benefit of continuing EGFR-TKI in combination with double-platinum chemotherapy (treatment beyond progression). This study aimed to compare chemotherapy effects of double-platinum plus EGFR-TKI versus double-platinum alone on patients with NSCLC progression after EGFR-TKI treatment. This was an analytical descriptive study using prospective cohort design, involving 30 patients with disease progression following EGFR-TKI treatment that met inclusion criteria in Dr. Soetomo Hospital. Subjects were divided into two groups: arm A (double-platinum plus EGFR-TKI) and arm B (double-platinum alone). Subjects were observed until 4 cycles of double-platinum chemotherapy. Subjective response (body weight and EQ5D questionnaire) was analyzed, chest CT scans were evaluated using RECIST criteria, and adverse effects were monitored. This study was conducted in accordance with GCP principles and has received ethics certificate from Dr. Soetomo Hospital ethics committee (No. 08/Panke.KKE/I/2017). The results showed that subject characteristics between two arms were insignificantly different (p=0.05). The most common EGFR mutation was exon 21 (50% on arm A and 60% on arm B). Chi square was tested on subjective response parameter (EQ5D (p=0.483)). T2 free sample was tested on semi-subjective parameter (body weight (p=1.00)). Comparison test on both groups after cycle 2 and 4 showed p value=0.05. Statistical test on adverse effect between both groups showed p value=0.526. As a conclusion, there was no significant difference between double-platinum and double-platinum plus EGFR-TKI on patients who had disease progression following EGFR-TKI treatment.