Radiation therapy and molecular-targeted agents in preclinical testing for immunotherapy, brain tumors, and sarcomas: Opportunities and challenges

Pediatr Blood Cancer. 2021 May;68 Suppl 2:e28439. doi: 10.1002/pbc.28439. Epub 2020 Aug 22.


Despite radiation therapy (RT) being an integral part of the treatment of most pediatric cancers and the recent discovery of novel molecular-targeted agents (MTAs) in this era of precision medicine with the potential to improve the therapeutic ratio of modern chemoradiotherapy regimens, there are only a few preclinical trials being conducted to discover novel radiosensitizers and radioprotectors. This has resulted in a paucity of translational clinical trials combining RT and novel MTAs. This report describes the opportunities and challenges of investigating RT together with MTAs in preclinical testing for immunotherapy, brain tumors, and sarcomas in pediatric oncology. We discuss the need for improving the collaboration between radiation oncologists, biologists, and physicists to improve the reliability, reproducibility, and translational potential of RT-based preclinical research. Current translational clinical trials using RT and MTAs for immunotherapy, brain tumors, and sarcomas are described. The technologic advances in experimental RT, availability of novel experimental tumor models, advances in immunology and tumor biology, and the discovery of novel MTAs together hold considerable promise for good quality preclinical and clinical multimodality research to improve the current rates of survival and toxicity in children afflicted with cancer.

Trial registration: ClinicalTrials.gov NCT00356031 NCT02050919 NCT02180867 NCT03116529 NCT03463408 NCT03217266 NCT02787642 NCT04220229 NCT03868852 NCT03361436 NCT02275286.

Keywords: brain tumors; immunotherapy; molecular-targeted agents; physics; radiation therapy; sarcomas.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Brain Neoplasms / immunology
  • Brain Neoplasms / pathology
  • Brain Neoplasms / therapy*
  • Chemoradiotherapy / methods*
  • Child
  • Humans
  • Immunotherapy / methods*
  • Molecular Targeted Therapy*
  • Radiation-Sensitizing Agents / therapeutic use
  • Sarcoma / immunology
  • Sarcoma / pathology
  • Sarcoma / therapy*


  • Antineoplastic Agents
  • Radiation-Sensitizing Agents

Associated data

  • ClinicalTrials.gov/NCT00356031
  • ClinicalTrials.gov/NCT02050919
  • ClinicalTrials.gov/NCT02180867
  • ClinicalTrials.gov/NCT03116529
  • ClinicalTrials.gov/NCT03463408
  • ClinicalTrials.gov/NCT03217266
  • ClinicalTrials.gov/NCT02787642
  • ClinicalTrials.gov/NCT04220229
  • ClinicalTrials.gov/NCT03868852
  • ClinicalTrials.gov/NCT03361436
  • ClinicalTrials.gov/NCT02275286