The tumor microenvironment of medulloblastoma: from emerging biological insights to novel therapeutic targeting.

Medulloblastoma is the most common pediatric malignancy of the brain and spine and a major cause of childhood cancer-related morbidity and mortality. Novel therapeutic approaches are urgently needed. The malignant behavior of this disease is influenced both by cell intrinsic factors and by the complex interactions of the tumor cells with its tumor microenvironment. Recent scientific and technological advancements allow increased ability to interrogate the microenvironment in terms of composition and cellular and signaling crosstalk, which together are critical for the regulation of tumor survival, disease proliferation, metastasis, and response to treatment. We summarize the current understanding of the medulloblastoma tumor microenvironment and explore its influence on disease pathogenesis, as well as identify emerging opportunities to leverage the microenvironment as a novel therapeutic target.