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Soon Hin How,1,2 Chong Kin Liam,3 Muhammad Adil Zainal Abidin,1 Harissa H Hasbullah,4,5 Lye Mun Tho,6 Gwo Fuang Ho,7 Ibtisam Muhamad Nor,5 Yong Kek Pang,3 Kean Fatt Ho,8 Muthukkumaran Thiagarajan,5 Roziana Ariffin,9 Azlina Samsudin,10 Azza Omar,11 Sin Nee Tan,2 Choo Khoon Ong,12 Sing Yang Soon,13 Mau Ern Poh3 1Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia; 3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Selangor, Malaysia; 5Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 6Department of Clinical Oncology, Beacon Hospital, Petaling Jaya, Selangor, Malaysia; 7Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 8Mount Miriam Cancer Hospital, Penang, Malaysia; 9Hospital Tunku Azizah, Kuala Lumpur, Malaysia; 10Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia; 11Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia; 12Gleneagles Hospital, Penang, Malaysia; 13Sarawak Heart Centre, Kuching, Sarawak, MalaysiaCorrespondence: Mau Ern Poh, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, Tel +60 3 7949 4422, Email ernestpoh@gmail.comBackground: Although first- and second-generation EGFR TKIs are considered first-line treatment in EGFRm+ NSCLC, most patients develop resistance and progress, commonly, EGFR T790M mutation. The third-generation EGFR-TKI has demonstrated efficacy in patients with progressive disease harboring the T790M mutation and in the first-line setting, bypassing this mode of resistance. The primary objectives of this study are to describe the proportion of EGFRm+ NSCLC patients treated with first-, second- and third-generation EGFR TKIs, and cytotoxic chemotherapy in the first-line setting, and the time on treatment for each category. Secondary objectives are to determine the dropout rate, the rates for T790M mutation testing at disease progression and the type of subsequent treatment.Methods: This multicenter retrospective study utilized data from the Malaysian Lung Cancer Registry that actively registers all lung cancer patients ≥ 18 years, with primary lung cancer confirmed histologically or cytologically. All patients diagnosed with advanced stages (ie stages IIIB, IIIC and IV) EGFRm+ NSCLC from 1st of January 2015 to 31st December 2019 were included.Results: Of 406 patients with EGFRm+ NCSLC, 351 were treated. Types of first-line treatment were as follows: EGFR-TKIs (first generation – 54.1%, second generation – 25.6% and third-generation – 12.5%) and chemotherapy (7.7%). The median time of treatment for each generation of EGFR-TKI was 12 months, 12 months and 24 months, and 2 months for chemotherapy. The dropout rate was 28.7% (n = 101). Nearly half (49.4%) of patients who were on first- or second-generation EGFR-TKI had further genetic testing via liquid or tissue biopsies upon disease progression. About 24.9% of those who developed disease progression after first- or second-generation EGFR TKI were started on a third-generation EGFR TKI.Conclusion: In the real-world, the management of EGFRm+ advanced NSCLC patients in an Asian cost-restrictive setting may adversely affect the choice of first-line therapy, time on each line of treatment and subsequently the overall survival of patients.Keywords: tyrosine kinase inhibitors, lung cancer, time on treatment, overall survival

Mau Ern Poh,1 Soon Hin How,2,3 Gwo Fuang Ho,4 Yong Kek Pang,1 Harissa H Hasbullah,5,6 Lye Mun Tho,7 Ibtisam Muhamad Nor,6 Bee Chiu Lim,3 Kean Fatt Ho,8 Muthukkumaran Thiagarajan,6 Azlina Samsudin,9 Azza Omar,10 Choo Khoon Ong,11 Sing Yang Soon,12 Justin Yu Kuan Tan,9 Muhammad Adil Zainal Abidin2 1Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; 2Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 3Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia; 4Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; 5Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Selangor, Malaysia; 6Oncology and Radiotherapy Department, General Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 7Department of Clinical Oncology, Beacon Hospital, Petaling Jaya, Selangor, Malaysia; 8Mount Miriam Cancer Hospital, Tanjong Bungah, Penang, Malaysia; 9Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia; 10Respiratory Unit, Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia; 11Gleneagles Penang, George Town, Penang, Malaysia; 12Sarawak Heart Centre, Kuching, Sarawak, MalaysiaCorrespondence: Mau Ern Poh, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia, Tel +60-3-7841-4000, Email ernestpoh@gmail.comPurpose: Anaplastic lymphoma kinase (ALK) inhibitors are associated with good overall survival (OS) for ALK-positive metastatic non–small cell lung cancer (NSCLC). However, these treatments can be unavailable or limited by financial constraints in developing countries. Using data from a nationwide lung cancer registry, the present study aimed to identify treatment patterns and clinical outcomes of ALK-positive NSCLC in Malaysia.Methods: This retrospective study examined data of patients with ALK-positive NSCLC from 18 major hospitals (public, private, or university teaching hospitals) throughout Malaysia between January 1, 2015 and December 31, 2020 from the National Cardiovascular and Thoracic Surgical Database (NCTSD). Data on baseline characteristics, treatments, radiological findings, and pathological findings were collected. Overall survival (OS) and time on treatment (TOT) were calculated using the Kaplan–Meier method.Results: There were 1581 NSCLC patients in the NCTSD. Based on ALK gene-rearrangement test results, only 65 patients (4.1%) had ALK-positive advanced NSCLC. Of these 65 patients, 59 received standard-of-care treatment and were included in the analysis. Crizotinib was the most commonly prescribed ALK inhibitor, followed by alectinib and ceritinib. Patients on ALK inhibitors had better median OS (62 months for first-generation inhibitors, not reached at time of analysis for second-generation inhibitors) compared to chemotherapy (27 months), but this was not statistically significant (P=0.835) due to sample-size limitations. Patients who received ALK inhibitors as first-line therapy had significantly longer TOT (median of 11 months for first-generation inhibitors, not reached for second-generation inhibitors at the time of analysis) compared to chemotherapy (median of 2 months; P< 0.01).Conclusion: Patients on ALK inhibitors had longer median OS and significantly longer TOT compared to chemotherapy, suggesting long-term benefit.Keywords: ALK inhibitors, chemotherapy, ALK-positive, NSCLC

The traditional food of a culture in a society is continuously inherited from the old generation to the new generation. The traditional element is an in-depth understanding of the function of each material, techniques of preparation, and the practice in our daily cooking. This understanding in the form of preparation, meal preparation, tips, use of certain equipment, and raw materials are mysteries difficult to be unravelled. The Malay cultural heritage food is an integral asset among Malaysians in general and the Malay race in particular. Malay cuisine is one of the special and unique blended of many traditions from around the region. However, when Malay culture and cuisine are introduced to other countries, they faced certain hurdles and challenges. This study investigates the issues and challenges faced by Malay cuisine in the foreign market. The points in question are, 1) Why are Malay cuisine difficult to be exported to other countries 2) Why Malay cuisine is less popular than cuisines from other countries? 3) What are the factors that make foods from a country of origin can be successfully exported? These issues and challenges will be parsed and discussed based on the existing written collection. Recommendations will be made on the mechanisms that enable the success of Malay cuisine food to be commercialized abroad, as well as future research examining the success factors of traditional food exported abroad.

Competent and loyal employees are the backbone to hotel operation and are seen as the greatest asset. This study investigates the relationship of career development and job security toward employee loyalty at luxury resort in Terengganu, Malaysia. A quantitative approach consists of questionnaire that included measures of career development, job security and employee loyalty was administered. A total of 60 usable data was analyzed using Pearson correlation coefficient. Alpha value showed that the items of the instrument had preferable value. Importantly, career development (M=3.64, SD=.928) and job security (M=3.70, SD=.768) are positively correlated to employee loyalty. It revealed that non-monetary benefits i.e. job security and career development had positive impact on employee loyalty. Developing and improving the dimensions would greatly assist hotel operators to create loyal employees for mutual benefits of the employees and the hotel.

Due to customer's changing demand and increased competition among restaurants, brand has become vital for the business to succeed. One of the strategies is to focus on improving their brand to add value to the restaurants. Brand equity holds the key element of differentiation among competitors and this has been regarded as valuable asset. This study employed four dimensions of customer-based brand equity; brand loyalty, perceived quality, brand awareness and brand association in determining the customer-based brand equity ratings. The study was conducted in three different family restaurant brands in Klang Valley with 349 usable questionnaires were analyzed by using one-way ANOVA. The Scheffe's test result proved that The Chicken Rice Shop was significantly different from others and obtained a higher brand equity rating (M=5.17, SD=.81). However, Pizza Hut (M=4.51, SD=.97) and Rasamas (M=4.30, SD=1.12) did not significantly different to each other. The implications and recommendations for restaurant operators and practitioners were also highlighted.