Growing up in Western Pennsylvania in the 1980s, both of us learned about sarcoma the hard way: by being diagnosed with it. As teenagers facing a rare and aggressive bone cancer, we received nearly the identical chemotherapy regimen that children receive today.
Four decades later, that is not a sign of success. It is a sign of stagnation.
Toxic and debilitating
Despite remarkable advances in cancer genomics, immunotherapy, and targeted therapies, the treatment backbone for sarcoma has changed little since the Reagan administration. (The “treatment backbone” is the standard treatment for a particular disease. Other treatments can be added to it to make the overall care more effective.)
For bone sarcomas like osteosarcoma, the standard regimen — three medicines called doxorubicin, cisplatin, and high-dose methotrexate — remains essentially identical to what we received as adolescents.
This regimen is toxic, debilitating, and often ineffective when the disease spreads. Patients still lose limbs, as we have. Too many still lose their lives.
This lack of progress is not due to a lack of effort. Sarcoma is rare, representing less than 1% of adult cancers, which makes large clinical trials difficult to conduct and financially unattractive for drug developers.
As a result, many patients face a cruel cycle of trial-and-error medicine: try a drug, wait, watch it fail, move on to the next. Each failure brings more side effects, more medical debt, more emotional exhaustion, and less hope of a cure.
Today, as a cancer surgeon/scientist and a healthcare entrepreneur — and as two people alive solely because researchers before us refused to accept the status quo — we are working together on an approach that could change how oncologists choose treatments.
It starts in Pittsburgh, and it begins with sarcoma.
Cancer treatment today often relies on genomic testing to look for mutations that can be targeted with specific drugs. Genomics is powerful, but for many solid tumors — including sarcomas — it does not reliably predict which therapy will actually help a patient. The patient may have one of those mutations, but for other reasons — resistance pathways, tumor heterogeneity, and redundant signaling networks — the drug will do nothing at all.
The result is guesswork disguised as precision medicine.
What patients need is something more fundamental: a way to see whether a drug will work before we give it to them.
Real-world biology
A new method, functional drug sensitivity testing (DST), addresses this gap directly. Instead of guessing a drug’s response based on genomics, DST exposes the patient’s tumor cells to a broad panel of cancer medications and measures which drugs actually kill the cells.
This approach captures the real-world biology of a tumor, including resistance mechanisms that genomic tests cannot see. It also enables the potential to observe the most precious discovery, an effective drug that nobody would have predicted.
This is not abstract theory. Preliminary data, including research from the University of Miami, show that functional testing can identify unexpected treatments that deliver real clinical benefit, even in patients who have exhausted standard therapies. Because the method tests existing FDA-approved drugs, promising options can move to patients quickly.
Sarcoma is the ideal proving ground for this approach. It is rare. It is deadly. And it has been scientifically neglected. But it also offers something rare in oncology: a motivated clinical community that is eager for innovation.
Pittsburgh has long been a sarcoma epicenter, with pioneering surgeons and internationally recognized research programs. The city also has a concentration of survivors, families, and advocacy groups who understand the urgency of new solutions. Starting here is both practical and personal.
What we learn from sarcoma will not stay in sarcoma. Once validated, DST can be extended to more common cancers like lung and colorectal cancer, where many patients also endure cycles of ineffective therapies and unnecessary toxicity.
The long-term vision is clear: stop guessing and start measuring. Combine genomics and DST to provide oncologists with a comprehensive view. Use AI models to predict effective drug combinations from single-agent data. Build a national reference network that brings this technology to every major cancer center.
And do it in Pittsburgh.
Pittsburgh’s resources
Pittsburgh can and should lead this movement. The region has the scientific talent, the clinical expertise, and the lived experience to push cancer care into a new era. But like any medical innovation, this requires investment from policymakers, health systems, philanthropic organizations, and insurers willing to reimburse new technologies that spare patients from ineffective and wasteful treatments.
As two survivors who were once treated with toxic drugs that remain the standard of care today, we believe Western Pennsylvania can do better and change the national conversation about rare cancers. The lives of future patients depend on it.
We survived the 1980s version of sarcoma. Today’s patients deserve better than the 1980s version of chemotherapy.
Kurt R. Weiss is a professor of Orthopaedic Surgery and director of the Musculoskeletal Oncology Laboratory at the University of Pittsburgh. Douglas P. McCormack is CEO of Acumen Partners.
With Ines Lohse, the co-director of the Musculoskeletal Oncology Laboratory, they created Biocerta, a Pittsburgh-based company developing the use of DST. The platform can test nearly 200 compounds using a small amount of tissue to provide quantitative drug sensitivity scores.