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Lieke Feijen

Lieke Feijen
Cardiotoxicity in childhood cancer survivors
Phone 088 97 25 192

After my PhD on LATER 1 study about symptomatic cardiotoxicity, I stayed on as a post-doc in group Kremer with cardiotoxicity as speciality. Together with other experts in the field (L. Kremer, A. Mavinkurve-Groothuis, W. Kok (cardiologist Amsterdam UMC, L. Kapusta (pediatric cardiologist Radboudumc), J. Loonen (pediatric oncologist Radboudumc) we received funding from the Dutch Heart Association to perform the LATER CARD study.

LATER study CARD: Survival of childhood cancer has improved importantly. Despite this success, childhood cancer survivors (CCS) have an increased risk of serious cardiac diseases as result of cardiotoxic cancer treatment. These cardiac diseases are related to increased morbidity and non-cancer mortality. As part of the Dutch LATER study approximately 1600 CCS and 250 siblings underwent clinical and cardiac assessments (blood samples, electrocardiography, echocardiography) between 2016 and 2020. The goal of this study is to identify more risk factors and to provide extended evidence for recommendation on cardiotoxicity surveillance.

Together with other experts in the field (L. Kremer, A. Mvinkurve-Groothuis, H. Grotenhuis (pediatric cardiologist WKZ) and T. Leiner (radiologist UMC Utrecht) we received funding from the KiKa to perform the pilot EARLY study.

EARLY study: Early detection of subclinical cardiotoxicity during treatment is crucial, to allow for timely intervention and to prevent further progression of cardiac disease. Despite the ubiquitous availability and low costs, serial routine echocardiography is not suitable to detect early preclinical abnormalities because it only allows to detect overt systolic cardiac dysfunction. Recently introduced advanced echocardiography and magnetic resonance imaging (MRI) techniques have demonstrated the potential to detect subclinical cardiac abnormalities in an earlier phase with myocardial deformation analysis, quantification of myocardial fibrosis and scar tissue, and delineation of the maladaptive changes of the heart in response to myocyte injury. The aim of the proposed study is to assess the extent to which early, subclinical cardiac dysfunction can be identified with advanced echocardiography and MRI techniques at specific time-points prior, during and shortly after initiation of treatment (for acute and early onset cardiotoxicity) in children receiving anthracyclines and/or radiotherapy as part of their cancer treatment. Combined with a detailed medical history and electrocardiogram (ECG) for potentially increased susceptibility for cardiotoxicity, this will allow for a comprehensive assessment of potential risk factors and disease course of early cardiac disease, and provide insights for potential new strategies to treat and/or prevent early and late cardiac disease.

As the data steward of group Kremer, I am for example responsible for archiving all the research data of group Kremer.

Supervisor of: Jan Leerink, Remy Merkx and Esmée de Baat.

Supervisor: Leontien Kremer

Key Publications:

Feijen EAM, van der Pal HJ, van Dalen EC, Mulder RL, Bardi E, Kuehni C, Tissing WJ and Kremer LC. A new method to facilitate valid and consistent grading cardiac events in childhood cancer survivors using medical records. PloS one. 2014;9:e100432.

Feijen EA, Leisenring WM, Stratton KL, Ness KK, van der Pal HJ, Caron HN, Armstrong GT, Green DM, Hudson MM, Oeffinger KC, Robison LL, Stovall M, Kremer LC and Chow EJ. Equivalence Ratio for Daunorubicin to Doxorubicin in Relation to Late Heart Failure in Survivors of Childhood Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015;33:3774-80.

Feijen EA, Font-Gonzalez A, van Dalen EC, van der Pal HJ, Reulen RC, Winter DL, Kuehni CE, Haupt R, Alessi D, Byrne J, Bardi E, Jakab Z, Grabow D, Garwicz S, Jankovic M, Levitt GA, Skinner R, Zadravec Zaletel L, Hjorth L, Tissing WJ, de Vathaire F, Hawkins MM, Kremer LC and PanCareSurFup c. Late Cardiac Events after Childhood Cancer: Methodological Aspects of the Pan-European Study PanCareSurFup. PloS one. 2016;11:e0162778.

Feijen EAML, Font-Gonzalez A, Van der Pal HJH, Kok WEM, Geskus RB, Ronckers CM, Bresters D, van Dalen EC, van Dulmen-den Broeder E, van den Berg MH, van der Heiden-van der Loo M, van den Heuvel-Eibrink MM, van Leeuwen FE, Loonen JJ, Neggers SJCMM, Versluys ABB, Tissing WJE, Kremer LCM. Risk and temporal changes of heart failure among 5-year childhood cancer survivors: a DCOG-LATER study. . Journal of American Heart Association. 2019;8.

Feijen EAM, Leisenring WM, Stratton KL, Ness KK, van der Pal HJH, van Dalen EC, Armstrong GT, Aune GJ, Green DM, Hudson MM, Loonen J, Oeffinger KC, Robison LL, Yasui Y, Kremer LCM and Chow EJ. Derivation of Anthracycline and Anthraquinone Equivalence Ratios to Doxorubicin for Late-Onset Cardiotoxicity. JAMA Oncol. 2019.