Abstract DNA-PK, the DNA-dependent protein kinase, is a validated target for cancer therapeutics that plays a central role in the non-homologous end joining (NHEJ) DNA repair pathway and the DNA damage response (DDR). NHEJ is a key mechanism of DNA double-strand breaks (DSB) repair, especially those induced by ionizing radiation (IR). Ku 70/80 heterodimer is required as initiator in this process, acting as an essential DNA-binding component of DNA-PK that senses DNA damage. Blocking the DNA-PK kinase activity in combination with DSB inducing agents has been widely used as a therapeutic strategy to drive clinical efficacy of radiation therapy for cancer treatment. We have reported a unique approach of DNA-PK inhibition by developing Ku-DNA binding inhibitors (Ku-DBi’s), small molecule inhibitors that target the interaction between Ku70/80 and DNA. Ku-DBi’s demonstrated a direct interaction with Ku70/80, a potent inhibition of Ku-DNA binding and DNA-PK catalytic activity, and in vitro and cellular NHEJ inhibitory activity. This results in the potentiation of non-small cell lung cancer (NSCLC) cellular sensitivity to DSB generating therapies, as a function of inhibiting DNA-PKcs autophosphorylation and dysregulation of signaling to the DDR. In this study, we have expanded our structure activity relationship analyses to focus on optimizing selectivity, cellular uptake and Ku inhibitory activity. The new series of Ku-DBi’s include oxindole derivatives of the X80 core structure that achieve these goals. These novel compounds display increased cellular uptake while retaining potent Ku inhibitory activity and enhanced cellular inhibition on DNA-DSB repair. Ku-DBi’s optimization has enabled in vivo analyses of Ku-DBi - ionizing radiation combination therapy in human xenograft models of non-small cell lung cancer. The impact of Ku-DBi treatment on therapeutic efficacy, toxicity, Ku/DNA-PK inhibition, and DDR signaling will be presented. These data represent a significant advance in the development of Ku-DNA binding inhibitors and their therapeutic intervention for cancer treatment. Citation Format: Pamela L. Mendoza-Munoz, Dineshsinha Chauhan, Navnath S. Gavande, Joseph R. Dynlacht, Joy E. Garrett, John J. Turchi. Novel Ku-DNA binding inhibitors impact on the cellular and in vivo DNA damage response to radio- and radiomimetic-therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7128.