Evidence map›Paper›PMID 41765359›Full record

ArticleCancer letters2026

DNA-PKcs promotes therapy resistance and metastatic recurrence in neuroblastoma.

Mahnaz Norouzi, Subin Kim, Beibei Zhu, Chi Wang, Natalie Wu, Katherine Somers, Eddy Shih-Hsin Yang, B Mark Evers, Eric J Rellinger, Piotr Rychahou

Abstract read
In one paragraph

Article in Cancer letters, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mahnaz NorouziMarkey Cancer Center, University of Kentucky, Lexington, KY, USA.
Subin KimMarkey Cancer Center, University of Kentucky, Lexington, KY, USA.
Beibei ZhuMarkey Cancer Center, University of Kentucky, Lexington, KY, USA; Department of Surgery, University of Kentucky, Lexington, KY, USA.
Chi WangDivision of Cancer Biostatistics, University of Kentucky, Lexington, KY, USA.
Natalie WuCincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Katherine SomersCincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Eddy Shih-Hsin YangDepartment of Radiation Medicine, University of Kentucky, Lexington, KY, USA.
B Mark EversMarkey Cancer Center, University of Kentucky, Lexington, KY, USA; Department of Surgery, University of Kentucky, Lexington, KY, USA.
Eric J RellingerMarkey Cancer Center, University of Kentucky, Lexington, KY, USA; Department of Surgery, University of Kentucky, Lexington, KY, USA. Electronic address: eric.rellinger@uky.edu.
Piotr RychahouMarkey Cancer Center, University of Kentucky, Lexington, KY, USA; Department of Surgery, University of Kentucky, Lexington, KY, USA. Electronic address: piotr.rychahou@uky.edu.

Funding

University of Kentucky Markey Cancer Center Support Grant ECIA SupplementP30CA177558 · NCI · UNIVERSITY OF KENTUCKY · PI Jennifer F Rogers · 2013 to 2026
$38.3M
NCI NIH HHS P30 CA177558
6 · The paper itself

Abstract

purposeHigh-risk neuroblastoma presents a serious clinical challenge with survival rates below 50%. Disease relapse most commonly occurs at distant metastatic sites and remains the primary driver of poor outcomes, emphasizing the need for therapies to target drivers of relapse. EXPERIMENTAL

designThis study identified DNA-PKcs as a critical determinant of poor survival and metastatic relapse in neuroblastoma patients. We evaluated which therapeutic modality-chemotherapy or radiotherapy-when combined with DNA-PKcs inhibition, more effectively reduces metastatic burden and prevents recurrence.

resultsColony-forming assays revealed that established neuroblastoma colonies resist doxorubicin alone and require high-dose doxorubicin paired with DNA-PKcs inhibition to suppress progression. In contrast, low-dose radiotherapy in combination with DNA-PKcs inhibition effectively controlled colony progression. Maximal synergy between radiotherapy and DNA-PKcs inhibition was achieved when the inhibitor was administered within 4 h post-irradiation. Chronic co-exposure to doxorubicin and peposertib encouraged emergence of therapy-resistant cells, whereas chronic co-exposure to radiotherapy combined with peposertib disrupted neuroblastoma cells self-renewal and prevented long-term colony maintenance. In neuroblastoma metastases, adding DNA-PKcs inhibition to doxorubicin improved efficacy but induced gastrointestinal side effects and failed to eradicate tumors; pairing it with low-dose, fractionated radiotherapy resulted in total lesion regression, impaired tumor self-renewal, and prevented systemic adverse effects.

conclusionsOur findings correlate elevated DNA-PKcs levels with poor patient prognosis and show that low-dose radiotherapy combined with peposertib effectively abrogates neuroblastoma self-renewal compared to chemotherapy-based regimens, thereby implicating DNA-PKcs as a key mediator of metastatic relapse and supporting radiotherapy plus DNA-PKcs inhibition as a compelling therapeutic strategy for relapsed or refractory high-risk neuroblastoma.

Indexed as

DNA-Activated Protein KinaseDrug Resistance, NeoplasmNeoplasm Recurrence, LocalNeuroblastomaNuclear ProteinsAnimalsCell Line, TumorDoxorubicinHumansMiceProtein Kinase InhibitorsXenograft Model Antitumor AssaysDNA-Activated Protein KinaseDoxorubicinNuclear ProteinsPRKDC protein, humanProtein Kinase InhibitorsApoptosisDNA double strand breaksDNA-PKcsHigh risk neuroblastomaIonizing radiationTopoisomerase II inhibitors

Identifiers

PMID41765359
PMCPMC13093346

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.