COG ANBL1531

COG ANBL1531, trial NCT03126916 run by the Children's Oncology Group, is the current North American trial for newly diagnosed high-risk neuroblastoma, adding iodine-131 MIBG targeted radiation during induction in a randomised comparison for MIBG-avid tumours and the ALK inhibitor lorlatinib in a non-randomised arm for children whose tumours carry ALK aberrations. It also tests reduced-intensity therapy in the standard arm and tracks uptake of eflornithine maintenance, with the primary MIBG randomisation results expected in 2026 to 2027 and encouraging response rates reported from the lorlatinib arm. OnCo links it to paediatric neuroblastoma, MIBG imaging and therapy, ALK as a target, 131I-MIBG therapy, lorlatinib, the Children's Oncology Group and Yael P. Mossé. Whether targeted radiation during induction improves cure rates is the question it will answer.