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

Abstract

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.

Radioresistance in rhabdomyosarcomas: Much more than a question of dose

“…On the benchside, RMS biopsies overexpressing PARP1, PARP2, and PARP3 mRNAs compared with normal skeletal muscle and PARPi have been demonstrated to affect growth, survival, and radiation susceptibility of human ARMS and ERMS cell lines ( 110 , 111 ). However, on the bedside, clinical trials testing PARPi on sarcomas, not including RMS, failed ( 112 , 113 ), whereas a recent phase I trial (NCT02787642) combining the PARPi with RT in locally advanced/unresectable STS, including RMS, is going to give encouraging downstaging and survival rates ( 114 ). Therefore, using PARPi could radiosensitize RMS independently of HRD or HRP phenotype because conventional RT, causing thousands of SSBs, would saturate the HR mechanisms inducing, in the presence of PARPi, RMS death, as already shown for other cancer types ( 115 ).…”