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"Pendahuluan: Saat ini, rejimen kemoterapi berbasis platinum dengan dua jenis obat seperti paklitaksel-karboplatin dan pemetreksat-karboplatin merupakan terapi lini pertama pasien adenokarsinoma paru dengan mutasi epidermal growth factor receptor (EGFR) negatif. Di rumah sakit Persahabatan, kedua rejimen tersebut banyak digunakan dan dijamin pembiayaannya oleh Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS). Dengan harga pemetreksat yang lebih mahal dan efektivitas yang belum diketahui, perlu dilakukan suatu kajian farmakoekonomi. Studi ini bertujuan untuk mengetahui profil efikasi, toksisitas, dan biaya paklitaksel-karboplatin dibandingkan pemetreksat-karboplatin.Metode: penelitian ini merupakan studi potong lintang, menggunakan data rekam medis. Pasien adenokarsinoma paru mutasi EGFR negatif yang pertama kali didiagnosa dan diterapi dengan paklitaksel-karboplatin atau pemetreksat-karboplatin dimasukkan ke dalam kriteria inklusi. Analisis farmakoekonomi dilakukan berdasarkan keluaran klinis yang terdiri dari efektivitas dan biaya medis langsung. Efektivitas dinilai berdasarkan overall response rate (ORR).Hasil: Rekam medis dari 21 pasien paklitaksel-karboplatin dan 21 pasien pemetreksat-karboplatin berhasil dievaluasi. Efektivitas kedua rejimen kemoterapi secara statistik tidak berbeda bermakna yang dilihat dari ORR (P=0,739). Toksisitas hematologi yang sering dialami oleh kedua kelompok adalah anemia, neutropenia, leukopenia derajat 1-2. Anemia, leukopenia, dan neutropenia derajat 3 lebih sering terjadi pada kelompok paklitaksel-karboplatin. Toksisitas nonhematologi kedua kelompok adalah mual muntah, rambut rontok, dengan neuropati perifer lebih banyak dialami kelompok paklitaksel-karboplatin. Melihat hal tersebut, pasien pada kelompok pemetreksat-karboplatin mengalami toksisitas lebih sedikit dibandingkan kelompok paklitaksel-karboplatin. Dari perhitungan analisis minimalisasi biaya diperoleh hasil bahwa biaya rerata per pasien dengan rejimen paklitaksel-karboplatin lebih murah Rp. 10.986.257,55 atau 50,25%, dibandingkan pemetreksat-karboplatin.Kesimpulan: tidak ada perbedaan efektivitas antara kedua rejimen. Biaya rerata per pasien dengan rejimen paklitaksel-karboplatin lebih murah dibandingkan pemetreksat-karboplatin. Diperlukan penelitian prospektif dengan jumlah subjek yang lebih besar dan melibatkan banyak rumah sakit.

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Background: At present, platinum-based chemotherapy regimens with two types of drugs such as paclitaxel-carboplatin and pemetrexed-carboplatin are first-line therapy for pulmonary adenocarcinoma patients with negative epidermal growth factor receptor (EGFR) mutations. At Persahabatan Hospital, the two regimens are widely used and guaranteed by National Health Insurance. With the price of pemetrexed which is more expensive and the effectiveness is unknown, it is necessary to do a pharmacoeconomic study. This study aimed to determine the efficacy, toxicity, and cost profile of paclitaxel-carboplatin compared to pemetrexed-carboplatin.

Methods: This s is a cross-sectional study, using medical record data. Patients with pulmonary adenocarcinoma negative EGFR mutations first diagnosed and treated with paclitaxel-carboplatin or pemetrexed-carboplatin were included. A pharmacoeconomic analysis is performed on the basis of clinical outcomes consisting of effectiveness and direct medical costs. Effectiveness was assessed based on the overall response rate (ORR).

Results: Medical records from 21 patients with paclitaxel-carboplatin and 21 patients with pemetrexed-carboplatin were successfully evaluated. The effectiveness of the two chemotherapy regimens was not significantly different, which was seen from the ORR (P = 0.739). The most common hematologic toxicity experienced of the two groups are anemia, neutropenia, leukopenia grade 1-2. Anemia, leukopenia and neutropenia grade 3 are more common in paclitaxel-carboplatin group. The nonhematological toxicity of the two groups was nausea vomitus, hair loss, with peripheral neuropathy more experienced by paclitaxel-carboplatin group. Seeing this, patients in pemetreksat-carboplatin group experienced less toxicity compared to paclitaxel-carboplatin group. From the calculation of cost minimization analysis the results showed that the average cost per patient with pulmonary adenocarcinoma negative EGFR mutation with paclitaxel-carboplatin regimen was cheaper Rp. 10.986.257,55 or 50,25%, compared to pemetrexed-carboplatin.

Conclusion: there was no difference in effectiveness between the two regimens. The average cost per patient with paclitaxel-carboplatin regimen was cheaper compared to pemetrexed-carboplatin. A prospective study is required with a larger number of study subjects and involves many hospitals."

"ABSTRAKLatar belakang: Keganasan merupakan salah satu penyakit tidak menular yang menjadi masalah kesehatan masyarakat, baik di dunia maupun di Indonesia. Salah satu modalitas pengobatan kasus keganasanadalah kemoterapi. Carboplatin cis-diammine-cyclobutanedicarboxylato platinum adalah senyawa platinum generasi kedua yang sering digunakan dalam tata laksana kasus keganasan seperti neuroblastoma, retinoblastoma, hepatoblastoma, tumor otak dan tumor sel germ. Efek samping pemberian obat sitotoksik perlu dipertimbangkan, khususnya ototoksik, yaitu gangguan fungsi dan kerusakan struktur telinga dalam yang dapat disebabkan oleh obat atau bahan kimia tertentu. Tujuan: Menilai efek ototoksisitas akibat pengaruh Carboplatin pada anak dengan kasus keganasan. Metode: Penelitian ini menggunakan desain serial cross sectional untuk mengetahui perubahan signal to noise ratio SNR pada OAE sebagai akibat efek ototoksik dan faktor-faktor risiko yang ikut berperan pada kejadian ototoksik akibat pemakaian Carboplatin di Divisi Hematologi Onkologi IKA FKUI-RSCM. Hasil: terdapat dua dari 52 subyek penelitian yang mengalami kejadian ototoksik. Kesimpulan: didapatkan dua 5 dari 40 subyek mengalami kejadian ototoksik pada kelompok yang mendapat kemoterapi, sedangkan pada kelompok yang belum mendapat terapi tidak ditemukan adanya nilai SNR kurang dari enam. Faktor risiko berupa jenis kelamin, usia, siklus kemoterapi dan dosis Carboplatin tidak memiliki hubungan yang bermakna secara statistik p>0,05 . Kata kunci: Carboplatin, ototoksik, otoacoustic emission OAE

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ABSTRACTBackground Malignancy is one of the non contagious diseases are a public health problem, both globally and Indonesia. Chemotherapy is one of modality in malignancy cases. Carboplatin cis platinum diammine cyclobutanedicarboxylato is a second generation platinum compound that is often used in the management of cases of malignancies such as neuroblastoma, retinoblastoma, hepatoblastoma, brain tumors and germ cell tumors. Side effects of cytotoxic drugs need to be considered, especially ototoxic. Ototoxic is disfunction and damage to the structure of the inner ear that can be caused by drugs or other certain chemicals. Objective Assess the effects of ototoxicity due to the influence of Carboplatin in children with malignancy cases. Methods This study uses a serial cross sectional design to assess changes in signal to noise ratio SNR at the OAE as a result of ototoxic effects and risk factors that come into play in the event due to the use of ototoxic Carboplatin in the Hematology Oncology of pediatric Department Cipto Mangunkusumo General Hospital. Results There are two of 52 study subjects, who experienced ototoxic. Conclusion we obtained two 5 of the 40 subjects experienced ototoxic events in the group receiving chemotherapy, whereas in the group that had not received therapy was not found SNR value less than six. The risk factors such as gender, age, Carboplatin dose cycles of chemotherapy and did not have a statistically significant relationship p 0.05 . "

"Pendahuluan: Tesis ini bertujuan untuk mengetahui efek myelosupresi padapasien kanker ovarium dengan kemoterapi ajuvan carboplatin dan paclitaxel diRSUPN dr. Cipto Mangunkusumo melalui analisis kadar hemoglobin, leukosit,dan trombosit. Kemoterapi ajuvan kombinasi carboplatin dan paclitaxelmerupakan rejimen kemoterapi yang paling efektif pada kanker ovarium. Namunpemberian kemoterapi tersebut memiliki efek samping myelosupresi sepertianemia, neutropenia, dan trombositopenia yang berdampak besar terhadapkualitas hidup pasien. Metode: Penelitian ini adalah penelitian hystorical cohort yang dilaksanakan diRSUPN Dr. Cipto Mangunkusumo dengan mengambil sampel penelitian pasienkanker ovarium yang mendapatkan kemoterapi ajuvan dengan carboplatin danpaclitaxel sebanyak enam seri mulai dari Januari 2010 sampai dengan Desember2014. Hasil: Dari 41 subjek penelitian yang memenuhi kriteria inklusi didapatkan usiapasien berkisar antara 25 sampai dengan 64 tahun (median: 49 tahun), terbanyakadalah multipara (43,9%), premenopause (61,0%), dengan stadium terbanyakadalah stadium IIIC (58,5%), histopatologi terbanyak adalah kistadenokarsinomaserosum (39,0%), dan sebagian besar berdiferensiasi sedang (48,8%). Kesimpulan: Sebagai kesimpulan didapatkan penurunan kadar hemoglobin, leukosit, dan trombosit yang bermakna pasca kemoterapi setiap seri (p < 0,001). ;Background: The objective of this study was to obtain the myelosupressioneffect on ovarian cancer patient with carboplatin and paclitaxel adjuvantchemotherapy based on haemoglobin, leucocyte, and thrombocyte level.Carboplatin and paclitaxel combination as an adjuvant chemotherapy is the mosteffective regiment for ovarian cancer. Otherwise this regiment hasmyelosuppression effect (hematologic toxicity) as anemia, neutropenia, andthrombocytopenia which have impact on quality of life of the patients. Methods: This is an hystorycal cohort study on ovarian caner patients whounderwent six series of adjuvant chemotherapy from January 2010 untilDecember 2014 at RSUPN Dr. Cipto Mangunkusumo. Results: From 41 patients range at 25 until 64 years old (median: 49 years), mostof them are multiparity (43,9%), premenopausal women (61,0%), with the largeststadium was IIIC (58,5%), the largest pathologic type was serouscystadenocarcinoma (39,0%) and most of them are intermediate differentiation(48,8%). Conclusions: As a conclusion there was a significantly decreased of haemoglobin, leucocyte, and thrombocyte levels after adjuvant chemotherapy on every single cycle (p<0,001). ;Background: The objective of this study was to obtain the myelosupressioneffect on ovarian cancer patient with carboplatin and paclitaxel adjuvantchemotherapy based on haemoglobin, leucocyte, and thrombocyte level.Carboplatin and paclitaxel combination as an adjuvant chemotherapy is the mosteffective regiment for ovarian cancer. Otherwise this regiment hasmyelosuppression effect (hematologic toxicity) as anemia, neutropenia, andthrombocytopenia which have impact on quality of life of the patients. Methods: This is an hystorycal cohort study on ovarian caner patients whounderwent six series of adjuvant chemotherapy from January 2010 untilDecember 2014 at RSUPN Dr. Cipto Mangunkusumo. Results: From 41 patients range at 25 until 64 years old (median: 49 years), mostof them are multiparity (43,9%), premenopausal women (61,0%), with the largeststadium was IIIC (58,5%), the largest pathologic type was serouscystadenocarcinoma (39,0%) and most of them are intermediate differentiation(48,8%). Conclusions: As a conclusion there was a significantly decreased of haemoglobin, leucocyte, and thrombocyte levels after adjuvant chemotherapy on every single cycle (p<0,001). "