After the seminal discoveries that TLK1 has important modulatory role in the DDR and DNA repair, the quest turned rapidly into trying to identify specific TLK inhibitors to enhance the effectiveness of XRT or radiomimetic drugs. This led to the initial identification of certain phenothiazines (PTH) antipsychotics as surprisingly specific TLK inhibitors that in fact enhanced the killing of cancer cells, in vitro and xenografts, when combined to IR or doxorubicin [
27]. A newer PTH scaffold, called J54, that substantially lacked anti-dopaminergic undesirable effect, showed very promising results in the regression of androgen-sensitive prostate cancer cells largely by passing the DDR and thereby enforcing entry unto catastrophic mitotic progression, even resulting in substantial tumor regression in SCID xenografts [
46]. Other studies of structure/function of TLKs have revealed additional potential inhibitors [
47]. Considering the availability of such drugs, of even greater importance now, is the rebound effort to target the activity of TLK1 on RAD9 and RAD54, with the obvious suggestion that both translesion (TSL) repair, single-strand gaps, and HRR can be simultaneously targeted. Various chemotherapeutic agents, therefore, fall under the umbrella of TLK inhibitors for their therapeutic potentiation. These include for example: topoisomerase poisons, bleomycin, MMC, PARPis, and cisplatin, all of which ultimately lead to the formation of SSBs and DSBs. For some of these (e.g., doxorubicin and cisplatin) direct evidence of synthetic lethality in combination with TLK inhibitors has already been verified [
27,
48]. Inhibiting TLK1 prior to radiation in diseases like GBM where base-excision repair is activated [
40] or cholangiocarcinoma or prostate cancer where intra-strand crosslink repair is elevated [
49] increases their chemo-sensitization, which suggests that TLK1 forms nexus of a vast spectrum of DNA repair mechanisms (
Figure 2). In addition to these obvious actionable targets via inhibitors of TLK1’s role in DNA repair and checkpoint surveillance, more recent functions for TLK1 in disparate important oncogenic pathways, such as regulation of AKT (via AKTIP); the important pro-metastatic kinase MK5; and the ultimate effector of the Hippo pathway, YAP (via NEK1) are coming to light (rev. in [
50]). In all the important roles of TLKs in various aspects of oncogenic development and as possible targets for various cancer-directed therapies is slowly but surely becoming ‘untousled’.