Radioligand therapy for pediatric patients with solid tumors

Abstract Despite significant advances in the treatment of childhood cancers, progress in improving outcomes for many pediatric solid tumors remains limited, particularly in patients with relapsed or metastatic disease. Current treatment strategies, including surgery, chemotherapy, and external beam radiotherapy, can achieve disease control but are often associated with substantial acute and long-term toxicities that affect long-term development and impact the overall quality of life of survivors. Radioligand therapy (RLT) has emerged as a promising targeted therapeutic strategy that combines tumor-specific ligands with radioactive isotopes, enabling the selective delivery of radiation to cancer cells while minimizing damage to surrounding healthy tissues. In adult oncology, RLT has demonstrated substantial clinical benefit in several malignancies, although this has not yet translated to pediatric cancers. Early clinical studies have explored the use of RLT in pediatric solid tumors, particularly in neuroblastoma, but the available evidence remains fragmented and is largely limited to small series. Therefore, this review aims to summarize the current clinical evidence on the use of RLT in pediatric solid tumors, including relevant molecular targets, radiopharmaceuticals, clinical outcomes, and safety profiles, and to discuss the key challenges and future directions for the development of RLT in pediatric oncology.