Roberto Iacovelli - Academia.edu (original) (raw)

Papers by Roberto Iacovelli

Expert Opinion on Emerging Drugs, 2015

Since both cytotoxic and cytokine therapy were not able to improve the prognosis of advanced rena... more Since both cytotoxic and cytokine therapy were not able to improve the prognosis of advanced renal cell carcinoma (RCC), this tumor has been a good model for the development of new biological agents in the past decade. Five VEGF receptor (VEGFR) and two mammalian target of rapamycin (mTOR) inhibitors are currently available for treatment of this disease but several issues need to be resolved such as a better definition of prognosis, the overcome of resistance and the best therapy for less frequent histologies. Areas covered: This review focuses on new tyrosine kinase inhibitors (TKIs) under investigation in these patients. Study design, phase of investigation, result and emerging toxicities were reported for each molecule. Combination trials involving TKIs with other strategies such as immunotherapy were also covered. Expert opinion: Despite the development of more potent and more specific VEGFR TKIs, all tumors ultimately develop resistance to therapy and a plateau has been reached in terms of overall survival. Current research effort to develop new agents aims at overcoming both the primary and the acquired resistance to anti-VEGFR TKIs focusing on new molecular pathways. The ultimate goal is not only to improve patient outcome but to achieve durable complete remission. Several pitfalls that have been responsible for failure of other compounds remain, especially the lack of strong predictive biomarkers and the use of inappropriate tumor assessment criteria that may not accurately capture response to these new therapies.

Cancer treatment reviews, Jan 8, 2016

Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altere... more Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altered pathways are involved in bladder tumorigenesis, representing therefore interesting targets for therapy. Tumor cells, including urothelial cancer cells, rely on a peculiar shift to aerobic glycolysis-dependent metabolism (the Warburg-effect) as the main energy source to sustain their uncontrolled growth and proliferation. Therefore, the high glycolytic flux depends on the overexpression of glycolysis-related genes (SRC-3, glucose transporter type 1 [GLUT1], GLUT3, lactic dehydrogenase A [LDHA], LDHB, hexokinase 1 [HK1], HK2, pyruvate kinase type M [PKM], and hypoxia-inducible factor 1-alpha [HIF-1α]), resulting in an overproduction of pyruvate, alanine and lactate. Concurrently, bladder cancer metabolism displays an increased expression of genes favoring the pentose phosphate pathway (glucose-6-phosphate dehydrogenase [G6PD]) and the fatty-acid synthesis (fatty acid synthase [FASN]), al...

Targeted Oncology, 2015

In a phase II study, we showed that temozolomide (TMZ) was tolerable and active in heavily pre-tr... more In a phase II study, we showed that temozolomide (TMZ) was tolerable and active in heavily pre-treated patients with advanced colorectal cancer (CRC) and MGMT methylation. A schedule of dose-dense TMZ may have enhanced activity due to the higher cumulative dose and induction of MGMT depletion, even in resistant tumors. Thirty-two patients with chemorefractory MGMT-methylated CRC were treated with TMZ at a daily dose of 75 mg/m(2) for 21 consecutive days every 4 weeks, for up to six cycles or until the occurrence of progressive disease/unacceptable toxicity. The primary endpoint was treatment activity in terms of objective response rate (ORR). MGMT protein expression was tested by immunohistochemistry (IHC) on two pooled cohorts: patients from the previous study of standard-dose TMZ and those from the current investigation. From November 2013 to December 2014, 32 patients were treated at Fondazione IRCCS Istituto Nazionale dei Tumori. We observed only three episodes of grade 3 asthenia and no significant myelotoxicity. The ORR was 16 % (all partial responses occurring in RAS-BRAF-mutated tumors). Median progression-free survival (PFS) and overall survival (OS) were 2.3 and 6.7 months, respectively. Patients with MGMT-low expression by IHC had a significantly higher ORR (p < 0.0001) and PFS (p = 0.001) compared to those with MGMT-high expression, while no difference was observed in OS. Our data confirm the encouraging activity of TMZ in chemorefractory CRC patients selected for MGMT silencing, even in the RAS-BRAF-mutated population. The role of MGMT IHC as a biomarker for improving patient selection warrants further prospective confirmation.

Critical Reviews in Oncology/Hematology, 2015

Chemotherapy is standard care in resected gastric cancer (GC). Despite the evidence that combinat... more Chemotherapy is standard care in resected gastric cancer (GC). Despite the evidence that combination chemotherapy (CT) increases overall survival (OS) as compared to single agent therapy in metastatic disease, no study proved this benefit in the adjuvant setting. We performed a systematic review and meta-analysis based on trial data on the role of combination over single agent CT as adjuvant treatment of GC. MEDLINE/PubMed and Cochrane Library were searched for randomized phase III trials that compared combination vs. single agent CT in patients treated with radical surgery for non-metastatic GC. Data extraction was conducted according to the PRISMA statement. Statistical analyses were conducted to calculate the summary hazard ratio (HR) for OS and disease free survival (DFS) and 95% Confidence Intervals (CIs) by using random-effects or fixed effects models based on the heterogeneity of included studies. A subgroup analysis was performed in patients treated with D2 lymphadenectomy. A total of 3572 patients were available for this analysis, 1857 received D2 lymphadenectomy, and fluoropyrimidine was given in 97% of patients of the control arm. In the overall population, the combined therapy decrease the risk of death by 13% (HR=0.87; 95%CI, 0.79-0.95; p=0.004) with fixed effect and by 19% (HR=0.81; 95%CI, 0.68-0.97; p=0.02) with random effect; significant heterogeneity was found. When analysis was limited to studies that required D2 lymphadenectomy a significant reduction of the risk of death was found in favor of combination CT (HR=0.86; 95%CI, 0.76-0.98; p=0.02). In the 3487 patients valuable for DFS, combination CT decreased the risk of relapse by 23% (HR=0.77; 95%CI, 0.70-0.84; p<0.001) with fixed effect and by 27% (HR=0.73; 95%CI, 0.49-1.09; p=0.12) with random effect; significant heterogeneity was found. This analysis reported that adjuvant combination CT decreases the risk of death over single agent therapy in patients with non-metastatic GC.

Oncotarget, Jan 13, 2015

Clear cell Renal Cell Carcinoma (ccRCC) is due to loss of von Hippel-Lindau (VHL) gene and at lea... more Clear cell Renal Cell Carcinoma (ccRCC) is due to loss of von Hippel-Lindau (VHL) gene and at least one out of three chromatin regulating genes BRCA1-associated protein-1 (BAP1), Polybromo-1 (PBRM1) and Set domain-containing 2 (SETD2). More than 350, 700 and 500 mutations are known respectively for BAP1, PBRM1 and SETD2 genes. Each variation damages these genes with different severity levels. Unfortunately for most of these mutations the molecular effect is unknown, so precluding a severity classification. Moreover, the huge number of these gene mutations does not allow to perform experimental assays for each of them. By bioinformatic tools, we performed predictions of the molecular effects of all mutations lying in BAP1, PBRM1 and SETD2 genes. Our results allow to distinguish whether a mutation alters protein function directly or by splicing pattern destruction and how much severely. This classification could be useful to reveal correlation with patients' outcome, to guide expe...

Cancer metastasis reviews, Jan 12, 2015

The outcome of patients with prostate cancer (PCa) is mainly dependent on the presence or absence... more The outcome of patients with prostate cancer (PCa) is mainly dependent on the presence or absence of distant metastases. Although several advances have been made in understanding the biological basis of this tumor, the mechanisms underlying PCa metastatic spread are not fully clear. The lack of a clear origin for PCa metastasis may be partially due to the evidence of PCa heterogeneity between primary tumor and metastases and among different metastatic sites. Cross-metastatic seeding and the de novo monoclonal seeding of daughter metastases have been proposed as crucial events during metastasis. This process requires the contribution of tumor environment, which modulates cancer cell homing and growth, and involves several components including cancer stem cells (CSCs), tumor secreted microvesicles, circulating tumor cells (CTCs), and immune cells. In this review, we have focused on the recent findings on the origin of prostate metastasis, showing the contribution of tumor microenviron...

Annals of Oncology, 2015

by amelia altavilla on August 1, 2015 http://annonc.oxfordjournals.org/ Downloaded from 2 abstrac... more by amelia altavilla on August 1, 2015 http://annonc.oxfordjournals.org/ Downloaded from 2 abstract Background

Canadian Urological Association Journal, 2015

Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapi... more Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor. Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progression-free survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria. Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates. The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival.

Therapeutic Advances in Urology, 2015

Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approv... more Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approved for the treatment of metastatic renal cell carcinoma (mRCC) after failure of first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor (TKI). In this narrative review, we aim to report the available evidence about the use of everolimus as second-line therapy for mRCC. A literature search was performed using PubMed/MEDLINE and abstracts from major conferences on clinical oncology as sources. We report data from prospective as well as retrospective and real world data studies and we analyze the safety and efficacy profile of everolimus as second-line therapy for mRCC. Although different drugs are currently available for the second-line treatment of mRCC, everolimus represents a feasible and safe option in this setting, especially for patients who have experienced high-grade toxicity or are still carrying TKI-related toxicities from first-line treatment.

Future Oncology, 2015

The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Rosen Shingle C... more The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Rosen Shingle Creek, Orlando, FL, USA, 26-28 February 2015 The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium was held in Orlando (FL, USA), from 26 to 28 February 2015. This meeting was focused on 'Integrating Biology into patient-centric care' and represented an attractive opportunity for oncology professionals with a special interest in the diagnosis and treatment of genitourinary tumors. The identification and validation of biomarkers for tumor response had been the focus of several researchers at the symposium, together with the development of novel targeted agents. This report is a summary of the highlights on kidney and prostate tumors presented at the 2015 ASCO Genitourinary Cancers Symposium by various investigators.

Nutrition Clinique et Métabolisme, 2011

Anticancer research

The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approxim... more The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approximately 3% of cervical cancers are diagnosed during pregnancy. The incidence of abnormal Pap smears has been reported to be 5%-8%. Data on the spontaneous evolution of an intraepithelial neoplasia during pregnancy are quite diverse. Of dysplasia cases diagnosed during pregnancy, 10%-70% regress and sometimes even disappear postpartum, while persistence in the severity of cervical neoplasia is reported in 25%-47% and progression occurs in 3%-30%. However, adequate follow-up and definitive management in the postpartum period is important. The objective of the study was to assess proper management of squamous intraepithelial lesion (SIL) during and after pregnancy, to assess regression, persistence and risk of progression and the predictive role of HPV tests. Thirty-one out of 721 pregnant women with a diagnosis of low- and high-grade SIL were observed. All patients were triaged using standar...

European Urology Supplements, 2013

The patient Fifty-seven year old heavy smorker female in good general conditions. Familiar histor... more The patient Fifty-seven year old heavy smorker female in good general conditions. Familiar history was negative for neoplastic disease. Recent diagnosis of hypertension with symptomatic hypertensive crises due to the presence of epystaxis. The woman is as healthcare worker in assisted-...

Expert Opinion on Emerging Drugs, 2015

Since both cytotoxic and cytokine therapy were not able to improve the prognosis of advanced rena... more Since both cytotoxic and cytokine therapy were not able to improve the prognosis of advanced renal cell carcinoma (RCC), this tumor has been a good model for the development of new biological agents in the past decade. Five VEGF receptor (VEGFR) and two mammalian target of rapamycin (mTOR) inhibitors are currently available for treatment of this disease but several issues need to be resolved such as a better definition of prognosis, the overcome of resistance and the best therapy for less frequent histologies. Areas covered: This review focuses on new tyrosine kinase inhibitors (TKIs) under investigation in these patients. Study design, phase of investigation, result and emerging toxicities were reported for each molecule. Combination trials involving TKIs with other strategies such as immunotherapy were also covered. Expert opinion: Despite the development of more potent and more specific VEGFR TKIs, all tumors ultimately develop resistance to therapy and a plateau has been reached in terms of overall survival. Current research effort to develop new agents aims at overcoming both the primary and the acquired resistance to anti-VEGFR TKIs focusing on new molecular pathways. The ultimate goal is not only to improve patient outcome but to achieve durable complete remission. Several pitfalls that have been responsible for failure of other compounds remain, especially the lack of strong predictive biomarkers and the use of inappropriate tumor assessment criteria that may not accurately capture response to these new therapies.

Cancer treatment reviews, Jan 8, 2016

Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altere... more Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altered pathways are involved in bladder tumorigenesis, representing therefore interesting targets for therapy. Tumor cells, including urothelial cancer cells, rely on a peculiar shift to aerobic glycolysis-dependent metabolism (the Warburg-effect) as the main energy source to sustain their uncontrolled growth and proliferation. Therefore, the high glycolytic flux depends on the overexpression of glycolysis-related genes (SRC-3, glucose transporter type 1 [GLUT1], GLUT3, lactic dehydrogenase A [LDHA], LDHB, hexokinase 1 [HK1], HK2, pyruvate kinase type M [PKM], and hypoxia-inducible factor 1-alpha [HIF-1α]), resulting in an overproduction of pyruvate, alanine and lactate. Concurrently, bladder cancer metabolism displays an increased expression of genes favoring the pentose phosphate pathway (glucose-6-phosphate dehydrogenase [G6PD]) and the fatty-acid synthesis (fatty acid synthase [FASN]), al...

Targeted Oncology, 2015

In a phase II study, we showed that temozolomide (TMZ) was tolerable and active in heavily pre-tr... more In a phase II study, we showed that temozolomide (TMZ) was tolerable and active in heavily pre-treated patients with advanced colorectal cancer (CRC) and MGMT methylation. A schedule of dose-dense TMZ may have enhanced activity due to the higher cumulative dose and induction of MGMT depletion, even in resistant tumors. Thirty-two patients with chemorefractory MGMT-methylated CRC were treated with TMZ at a daily dose of 75 mg/m(2) for 21 consecutive days every 4 weeks, for up to six cycles or until the occurrence of progressive disease/unacceptable toxicity. The primary endpoint was treatment activity in terms of objective response rate (ORR). MGMT protein expression was tested by immunohistochemistry (IHC) on two pooled cohorts: patients from the previous study of standard-dose TMZ and those from the current investigation. From November 2013 to December 2014, 32 patients were treated at Fondazione IRCCS Istituto Nazionale dei Tumori. We observed only three episodes of grade 3 asthenia and no significant myelotoxicity. The ORR was 16 % (all partial responses occurring in RAS-BRAF-mutated tumors). Median progression-free survival (PFS) and overall survival (OS) were 2.3 and 6.7 months, respectively. Patients with MGMT-low expression by IHC had a significantly higher ORR (p < 0.0001) and PFS (p = 0.001) compared to those with MGMT-high expression, while no difference was observed in OS. Our data confirm the encouraging activity of TMZ in chemorefractory CRC patients selected for MGMT silencing, even in the RAS-BRAF-mutated population. The role of MGMT IHC as a biomarker for improving patient selection warrants further prospective confirmation.

Critical Reviews in Oncology/Hematology, 2015

Chemotherapy is standard care in resected gastric cancer (GC). Despite the evidence that combinat... more Chemotherapy is standard care in resected gastric cancer (GC). Despite the evidence that combination chemotherapy (CT) increases overall survival (OS) as compared to single agent therapy in metastatic disease, no study proved this benefit in the adjuvant setting. We performed a systematic review and meta-analysis based on trial data on the role of combination over single agent CT as adjuvant treatment of GC. MEDLINE/PubMed and Cochrane Library were searched for randomized phase III trials that compared combination vs. single agent CT in patients treated with radical surgery for non-metastatic GC. Data extraction was conducted according to the PRISMA statement. Statistical analyses were conducted to calculate the summary hazard ratio (HR) for OS and disease free survival (DFS) and 95% Confidence Intervals (CIs) by using random-effects or fixed effects models based on the heterogeneity of included studies. A subgroup analysis was performed in patients treated with D2 lymphadenectomy. A total of 3572 patients were available for this analysis, 1857 received D2 lymphadenectomy, and fluoropyrimidine was given in 97% of patients of the control arm. In the overall population, the combined therapy decrease the risk of death by 13% (HR=0.87; 95%CI, 0.79-0.95; p=0.004) with fixed effect and by 19% (HR=0.81; 95%CI, 0.68-0.97; p=0.02) with random effect; significant heterogeneity was found. When analysis was limited to studies that required D2 lymphadenectomy a significant reduction of the risk of death was found in favor of combination CT (HR=0.86; 95%CI, 0.76-0.98; p=0.02). In the 3487 patients valuable for DFS, combination CT decreased the risk of relapse by 23% (HR=0.77; 95%CI, 0.70-0.84; p<0.001) with fixed effect and by 27% (HR=0.73; 95%CI, 0.49-1.09; p=0.12) with random effect; significant heterogeneity was found. This analysis reported that adjuvant combination CT decreases the risk of death over single agent therapy in patients with non-metastatic GC.

Oncotarget, Jan 13, 2015

Clear cell Renal Cell Carcinoma (ccRCC) is due to loss of von Hippel-Lindau (VHL) gene and at lea... more Clear cell Renal Cell Carcinoma (ccRCC) is due to loss of von Hippel-Lindau (VHL) gene and at least one out of three chromatin regulating genes BRCA1-associated protein-1 (BAP1), Polybromo-1 (PBRM1) and Set domain-containing 2 (SETD2). More than 350, 700 and 500 mutations are known respectively for BAP1, PBRM1 and SETD2 genes. Each variation damages these genes with different severity levels. Unfortunately for most of these mutations the molecular effect is unknown, so precluding a severity classification. Moreover, the huge number of these gene mutations does not allow to perform experimental assays for each of them. By bioinformatic tools, we performed predictions of the molecular effects of all mutations lying in BAP1, PBRM1 and SETD2 genes. Our results allow to distinguish whether a mutation alters protein function directly or by splicing pattern destruction and how much severely. This classification could be useful to reveal correlation with patients' outcome, to guide expe...

Cancer metastasis reviews, Jan 12, 2015

The outcome of patients with prostate cancer (PCa) is mainly dependent on the presence or absence... more The outcome of patients with prostate cancer (PCa) is mainly dependent on the presence or absence of distant metastases. Although several advances have been made in understanding the biological basis of this tumor, the mechanisms underlying PCa metastatic spread are not fully clear. The lack of a clear origin for PCa metastasis may be partially due to the evidence of PCa heterogeneity between primary tumor and metastases and among different metastatic sites. Cross-metastatic seeding and the de novo monoclonal seeding of daughter metastases have been proposed as crucial events during metastasis. This process requires the contribution of tumor environment, which modulates cancer cell homing and growth, and involves several components including cancer stem cells (CSCs), tumor secreted microvesicles, circulating tumor cells (CTCs), and immune cells. In this review, we have focused on the recent findings on the origin of prostate metastasis, showing the contribution of tumor microenviron...

Annals of Oncology, 2015

by amelia altavilla on August 1, 2015 http://annonc.oxfordjournals.org/ Downloaded from 2 abstrac... more by amelia altavilla on August 1, 2015 http://annonc.oxfordjournals.org/ Downloaded from 2 abstract Background

Canadian Urological Association Journal, 2015

Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapi... more Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor. Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progression-free survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria. Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates. The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival.

Therapeutic Advances in Urology, 2015

Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approv... more Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approved for the treatment of metastatic renal cell carcinoma (mRCC) after failure of first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor (TKI). In this narrative review, we aim to report the available evidence about the use of everolimus as second-line therapy for mRCC. A literature search was performed using PubMed/MEDLINE and abstracts from major conferences on clinical oncology as sources. We report data from prospective as well as retrospective and real world data studies and we analyze the safety and efficacy profile of everolimus as second-line therapy for mRCC. Although different drugs are currently available for the second-line treatment of mRCC, everolimus represents a feasible and safe option in this setting, especially for patients who have experienced high-grade toxicity or are still carrying TKI-related toxicities from first-line treatment.

Future Oncology, 2015

The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Rosen Shingle C... more The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, Rosen Shingle Creek, Orlando, FL, USA, 26-28 February 2015 The American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium was held in Orlando (FL, USA), from 26 to 28 February 2015. This meeting was focused on 'Integrating Biology into patient-centric care' and represented an attractive opportunity for oncology professionals with a special interest in the diagnosis and treatment of genitourinary tumors. The identification and validation of biomarkers for tumor response had been the focus of several researchers at the symposium, together with the development of novel targeted agents. This report is a summary of the highlights on kidney and prostate tumors presented at the 2015 ASCO Genitourinary Cancers Symposium by various investigators.

Nutrition Clinique et Métabolisme, 2011

Anticancer research

The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approxim... more The incidence of cervical cancer in pregnancy is estimated to be 1-10/10000 pregnancies. Approximately 3% of cervical cancers are diagnosed during pregnancy. The incidence of abnormal Pap smears has been reported to be 5%-8%. Data on the spontaneous evolution of an intraepithelial neoplasia during pregnancy are quite diverse. Of dysplasia cases diagnosed during pregnancy, 10%-70% regress and sometimes even disappear postpartum, while persistence in the severity of cervical neoplasia is reported in 25%-47% and progression occurs in 3%-30%. However, adequate follow-up and definitive management in the postpartum period is important. The objective of the study was to assess proper management of squamous intraepithelial lesion (SIL) during and after pregnancy, to assess regression, persistence and risk of progression and the predictive role of HPV tests. Thirty-one out of 721 pregnant women with a diagnosis of low- and high-grade SIL were observed. All patients were triaged using standar...

European Urology Supplements, 2013

The patient Fifty-seven year old heavy smorker female in good general conditions. Familiar histor... more The patient Fifty-seven year old heavy smorker female in good general conditions. Familiar history was negative for neoplastic disease. Recent diagnosis of hypertension with symptomatic hypertensive crises due to the presence of epystaxis. The woman is as healthcare worker in assisted-...