Medulloblastoma: Molecular understanding, treatment evolution, and new developments.

Area of Science:

• Pediatric Oncology
• Neuro-oncology
• Genetics and Epigenetics

Background:

• Medulloblastoma (MB) is the most common malignant pediatric brain tumor.
• Current treatments cause significant motor and cognitive defects.
• Individualized therapies targeting oncogenic drivers are needed.

Purpose of the Study:

• To review advances in MB classification.
• To discuss challenges in MB classification.
• To highlight therapeutic developments targeting molecular and epigenetic factors in MB subgroups, especially SHH-driven tumors.

Main Methods:

• Review of recent genetic and epigenetic findings in MB.
• Analysis of MB molecular subgroup classification (WNT, SHH, Group 3, Group 4, and emerging subtypes).
• Examination of inter- and intra-tumoral features within MB subgroups.

Main Results:

• MB classification has evolved from four to up to seven molecular subgroups.
• Subgroups exhibit distinct molecular and histopathological characteristics.
• Classification aids in risk stratification and improved clinical treatment options.

Conclusions:

• MB classification is crucial for personalized medicine.
• Targeting subgroup-specific molecular and epigenetic factors offers new therapeutic avenues.
• Further research into SHH-driven MB tumors is warranted.