Radioligand therapy for paediatric patients with solid tumours

Despite significant advances in the treatment of childhood cancers, progress in improving outcomes of many paediatric solid tumours 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 affecting long-term development, impacting the overall quality of life of survivors. Radioligand therapy (RLT) has emerged as a promising targeted therapeutic strategy that combines tumour-specific ligands with radioactive isotopes, enabling the selective delivery of radiation to cancer cells while minimising damage to surrounding healthy tissues. In adult oncology, RLT has demonstrated substantial clinical benefit in several malignancies, which has not (yet) translated into paediatric cancers. Early clinical studies have explored the use of RLT in paediatric solid tumours, particularly in neuroblastoma, but the available evidence remains fragmented and largely limited to small series. Therefore, this review aims to summarise the current clinical evidence on the use of RLT in paediatric solid tumours, 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 paediatric oncology.