Crystal Lee

republicanherald.com 23 S. Centre St.,2nd Floor Pottsville, PA 17901 Phone: 570-622-3456 Email: [email protected]

republicanherald.com 23 S. Centre St.,2nd Floor Pottsville, PA 17901 Phone: 570-622-3456 Email: [email protected]

republicanherald.com 23 S. Centre St.,2nd Floor Pottsville, PA 17901 Phone: 570-622-3456 Email: [email protected]

republicanherald.com 23 S. Centre St.,2nd Floor Pottsville, PA 17901 Phone: 570-622-3456 Email: [email protected]

republicanherald.com 23 S. Centre St.,2nd Floor Pottsville, PA 17901 Phone: 570-622-3456 Email: [email protected]

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Complex regional pain syndrome (CRPS) is a painful neuropathic condition that is often difficult to diagnose and treat in children. In patients who fail conservative treatment, an interventional approach can provide pain relief and improve functionality. We present a case in which an ultrasound-guided stellate ganglion block (SGB) was performed on a pediatric patient with refractory CRPS affecting the upper extremity. Following the block, the patient reported significant pain reduction, less frequent flares, and improvement of functions without any significant complications. This case report aims to highlight the effectiveness of ultrasound-guided SGB in treating pediatric CRPS patients. The recent advocacy of ultrasound-guided interventions has demonstrated efficacy and improved safety due to clear visualization of key structures.

Purpose: Mesothelin (MSLN) is highly expressed in high grade serous/ endometrioid ovarian cancers (HGOC). Anetumab ravtansine (AR) is an antibody drug conjugate directed at MSLN antigen with a tubulin polymerization inhibitor. We assessed safety, activity and pharmacokinetics of the combination AR/bevacizumab (Bev) (ARB) versus weekly paclitaxel (wP)/Bev (PB) in patients with platinum resistant/refractory HGOC (prrHGOC). Expiremental design: Following a run-in phase I study to assess ARB safety, prrHGOC patients with centrally confirmed MSLN positive expression were randomized to ARB or PB (wP 80mg/m2 with Bev 10mg/kg biweekly). Patients were stratified by platinum resistance/refractory and prior Bev. The primary endpoint was progression-free survival (PFS), secondary endpoints were overall response rate (ORR), safety, and blood-based angiome biomarker assessment. A futility analysis was planned after 35 PFS events. Results: The combination of Bev (10mg/kg) biweekly with AR (2.2mg/kg) weekly was well tolerated. Regarding phase II results, mesothelin positivity was 88% and 57 pts were randomized (28 ARB, 29 PB). 42% pts received prior Bev and 23% were platinum refractory. At futility analysis, the median PFS was 5.3 and 12.7 months for ARB and PB respectively (p=0.03, HR= 2.02 [1.06-3.86]). ORR was 21% with ARB and 65% with PB. The most common treatment-related grade ≥ 3 adverse events were anemia (18%) with ARB, and neutropenia (24%) with PB. Higher baseline levels of circulating IL-6 were associated with worse PFS, and its levels decreased with PB treatment. Conclusion: Our study stopped at interim analysis highlighting the benefit of PB in prrHGOC as standard of care.