Challenges and opportunities for treatment of medulloblastoma

Medulloblastoma (MB) stands out as the most prevalent, invasive, and biologically heterogeneous pediatric brain tumor. MB accounts for almost 1/4th of all intracranial neoplasms. The prime age of diagnosis is 5-9 years of age; however, the disease is also seen at a later age in approximately 25 % adults. The standard treatment for the disease is comprised of multimodal approaches incorporating surgery, radiation therapy, and adjuvant chemotherapy, which increases the survival to 70-80 %. Despite considerable progress in therapies and novel drug discoveries, 30 % of the survivors succumb to lifelong morbidities and chronic disabilities. A deeper understanding of the disease's molecular landscape has led to the identification of four distinct molecular subgroups: wingless (WNT), sonic hedgehog (SHH), Group 3 and Group 4. This classification, coupled with clinical-pathological assessments of the disease, has enhanced the search for more targeted and effective therapies for MB. In this review, we present an overview of MB, with an emphasis on current treatment options and challenges, utilization of molecular subgroup-specific genetic alterations in development of targeted therapies, including immunotherapy. Additionally, emerging nanomedicine approaches aimed at overcoming the inefficient blood brain barrier (BBB) penetration of drugs used for the treatment of MB, are discussed.