Screening and Cardio-surveillance of Cancer Patients Undergoing Immune Checkpoint Blockade

When immunotherapy was introduced in oncology, it revolutionized treatment for many cancers, including some that had no real treatment prior. However, it brought with it a hidden heart risk, and Dr. Sanjeev Francis of MaineHealth received his pilot award to try and detect these risks earlier. Oncologists noted that a small percent of patients receiving immunotherapies experience severe cardiovascular complications, and myocarditis is the one Dr. Francis says they worry about the most. This condition has high morbidity and mortality rates, even when detected early, so finding out which patients are at risk before symptoms start is critical. As immunotherapies are being used for more and more cancers, and multiple therapies are being used simultaneously in individual patients, the risk of this rare but serious cardiotoxicity is a growing concern. The project aims to answer two main questions: Is there a better way to understand who is at risk of myocarditis, and is there any signal that can be detected clinically using advanced cardiac monitoring that can alert clinicians to at risk patients before they start to show symptoms? Dr. Francis and his team recently enrolled the first patient and aim to enroll 25 total from across both urban and rural areas, which is something he feels is critical. As a clinician in our region, Dr. Francis believes the opportunity to enroll patients who have historically not participated in clinical research at this level fulfills part of the mission of our health system, so his project is focused on recruiting and supporting patients across the state of Maine, reaching to its most rural areas.

“The great part about the CTR program is that it created these connections with our translational scientists, and as a result of that, we used this concept to draft a larger grant that brought together more collaborators in Maine as well as partners outside of the state. This was all made possible because the CTR created an environment where we were thinking creatively about how we look at this clinical problem from different dimensions. So even before we enrolled our first patient, we had already taken the step of thinking bigger and expanding the project into bigger applications."

Sanjeev Francis, MD

"Immunotherapy for Cancer: The Hidden Heart Risk"

Deirdre O'Reilly, MD, MPH

"Rock a Bye Baby: How Well do Opioid-Exposed Newborns Sleep?"

Sleep Disturbance on Bedside EEG: A Biomarker for Neonatal Abstinence Syndrome

It’s hard enough being a patient in pain or discomfort and struggling to describe symptoms to the doctor, but what about when the patient is just an infant who can’t express those same details? Dr. Deirdre O’Reilly of the University of Vermont received her pilot award to investigate if doctors can use the electrical activity of the brain to know when infants are at risk of withdrawal. Working with Dr. Adrienne Pahl at UVM and a team of researchers across Vermont, Maine, and New Hampshire, their goal is to take emerging knowledge from laboratory and basic science around sleep and neurodevelopment and test the hypothesis that infants at risk of neonatal abstinence syndrome, or withdrawal, will have sleep disturbances. One challenge when identifying and treating infants experiencing withdrawal lies in their inability to explain their symptoms, so doctors need to rely on less objective measures. Drs. O’Reilly and Pahl were looking for something based on the underlying physiology of these babies, and applying EEG leads to see how their restful periods in sleep were and measure the underlying brain activity might give them a comparison showing differences between infants at risk of withdrawal and those who are not. The team is still collecting and analyzing data, and according to Dr. O’Reilly, their progress has been strengthened by their collaborations. Working under health and research systems like our hospitals and the NNE-CTR has provided a structure that she says is supporting researchers and interdisciplinary research teams.

“I thought this is something I want to do. I want to be involved in research that can really improve patient outcomes—take something we don’t know as much about, investigate it at the bedside, and lead to better outcomes."