Cancer treatment has evolved tremendously in the last few decades. Immunotherapy has been considered to be the forth pillar in cancer treatment in addition to conventional surgery, radiotherapy, and chemotherapy. Though immunotherapy has resulted in impressive response, it is generally limited to a small subset of patients. Understanding the mechanisms of resistance toward cancer immunotherapy may shed new light to counter that resistance. In this review, we highlighted and summarized two major hurdles (recognition and attack) of cancer elimination by the immune system. The mechanisms of failure of some available immunotherapy strategies were also described. Moreover, the significance role of immune compartment for various established cancer treatments were also elucidated in this review. Then, the mechanisms of combinatorial treatment of various conventional cancer treatment with immunotherapy were discussed. Finally, a strategy to improve immune cancer killing by characterizing cancer immune landscape, then devising treatment based on that cancer immune landscape was put forward.

Background: Cancer had caused 14,067,900 people suffered in 2012. In Indonesia, with 357,000 cases, added by mortality and morbidity, cancer has added the country double burden of disease. Thus, preventive measure should be done to tackle the problem. One of the best ways is health promotion through the massive campaign and multisectoral collaboration using the momentum of annual World Cancer Day (WCD). Annual WCD has been held by National Cancer Control Committee (NCCC)-Ministry of Health (MoH), however, 2017 is the kick-off event which engages multisector to promote cancer awareness and knowledge. Aim: This campaign aims to increase awareness and knowledge about cancer (including the healthy lifestyle, detection program and treatment) among Indonesian. Strategy: The national action was planned based on the strategic objective of NCCC. The campaign was coordinated by NCCC-MoH of Indonesia and implemented throughout the country. The local situation, condition and creativity were encouraged to ensure the successful campaign. Program process: Initial coordination was made by NCCC. The proposal was disseminated to the centers across Indonesia. Then, centers would carry out the event and report to the NCCC. Meanwhile, a massive campaign in Jakarta was held by NCCC. Outcomes: There were 25 out of 34 provinces, consisted of 18 nongovernmental organizations (NGOs), 20 professional societies, 37 hospitals and 25 provincial public health service involved in the WCD campaign. This WCD was held under decree of Minister of Health. Several programs in the WCD were press briefing, seminars, talk show, fun campaign in public areas (i.e., celebrity performance, yoga), promotion via local television/newspaper and social media; early detection such as Papanicolaou test, mobile mammography, breast ultrasound, clinical breast examination and visual inspection of acetic acid. The impact of WCD 2017 was tremendous compared with previous year, with multisectoral involvement, overloaded participants and broke the World of Record Museum-Indonesia (MURI) with the most dancer involved dance for the cancer survivor. In addition, the impact can be seen in 2018, when no decree of the minister and national movement provided. In 2018, NCCC only organized a training of trainer with the hope of having an extension of the hand to deliver knowledge and awareness. Nevertheless, each part of Indonesia was commemorating their own WCD without any coordination. These evidence showed that NCCC had been successful to increase awareness and knowledge about cancer. What was learned: Many people were involved in the preparation, starting from doctors, local government, NGOs, hospitals, MoH, companies, survivors and celebrities. Moreover, social media campaign and celebrities played a great role in making this event succeed. Therefore, multisector collaboration is an essential part of raising awareness and knowledge about cancer.

BACKGROUND: Osteoporosis is a chronic, progressive, systemic, skeletal, multifactorial disorder characterized by low bone mass, microarchitectural deterioration of bone tissues that increased the risk of fragility fracture. The increased prevalence of early osteoporosis in homocystinuria illustrates that homocysteine metabolism is involved in the process of osteoporosis. AIM: This study was aimed to look for the relationship between homocysteine levels in the blood and the occurrence of osteoporotic fractures in the population above 55 years old. METHODS: This is a descriptive study with cross-sectional approach, total sixty-five patients aged 55 years or older with osteoporotic fracture and as a control group without osteoporotic fracture. Blood pressure, heart rate, and body weight were recorded, bone density was measured using central dual-energy x-ray absorptiometry (DXA) machine/DXA and homocysteine plasma levels were measured using the enzyme-linked immunoassay method. RESULTS: Total of 65 samples with age range between 55 and 88 years, they were 38 peoples with osteoporosis, which 12 got the osteoporotic fracture. Among the 16 samples in osteopenia group, two got the fracture, among 11 samples with normal bone density, one got the osteoporotic fracture. There was statistical significant between fracture and bone mineral density (p = 0.00) and no statistical significant between bone density and gender (p = 0.08), bone density and body mass index (BMI) (p = 0.11). There was statistical significant correlation between homocysteine and age (p = 0.02), age and bone density (p = 0.002) but no statistical significant correlation between homocysteine and BMI (p = 0.07), homocysteine and osteoporotic fracture (p = 0.87). CONCLUSIONS: Homocysteine level did not increased the incidence of osteoporotic fracture, however homocysteine increased with aging and correlated with bone mineral density.

Background: The main therapy for head and neck cancer is radiation, and one of the toxic effects of radiation is radiation dermatitis. Aloe vera is a species of succulent plant of the genus Aloe, widely used in cosmetic and skin care products, as well as daikon (Raphanus sativus var. longipinnatus), which is high in antioxidants. Objectives: The present study aims to evaluate the potential benefits of Aloe vera and daikon gel combination in head and neck cancer patients to prevent radiation-induced dermatitis. Methods: A cohort study was conducted with eligible subjects, all head and neck cancer patients receiving radiation therapy selected in consecutive sampling. Samples were divided into two groups; either received Aloe vera and daikon combination gel (study group) or baby oil (control induced dermatitis (RID) were observed. Results: A total of 44 patients were grouped into intervention (Aloe vera-daikon gel) and control (baby oil) groups. After ten radiotherapies (RT) sessions, the intervention group had a lower percentage of grade 1 RID (35% vs. 91.7%, control: 65% grade 2 RID, P < 0.001). After 20 RT sessions, 40% had no dermatitis, while all patients had RID in the control group (P = 0.061). After 30 RT sessions, the intervention group had a lower RID grade overall (gr 0: 5%, gr 1: 85%, gr 2: 10%) compared to the control group (gr 1: 33.3%, gr 2: 54.3%, gr 3: 8.3%, P = 0.002). After 35 RT sessions, the intervention group also had a lower RID grade overall (gr 0: 5%, gr 1: 65%, gr 2: 20%, gr 3: 10%) compared to the control group (gr 1: 8.3%, gr 2: 37.5%, gr 3: 45.8%, gr 4: 8.3%, P < 0.001). Conclusions: The combination of Aloe vera and daikon gel showed promising results in reducing the severity of radiation-induced dermatitis for head and neck cancer patients.