Osteosarcoma treatment protocols remain largely unchanged since the 1980s, with 5-year survival rates plateaued at approximately 70% for localized disease and 20% for metastatic disease. Despite significant advances in genomic medicine for common cancers, the 400-500 Canadian families affected by osteosarcoma annually continue to navigate treatment decisions with limited evidence-based guidance.

Osteosarcoma exhibits extreme genomic instability, including chromothripsis events and complex structural rearrangements that create substantial heterogeneity even within individual tumors. This genomic chaos has historically confounded traditional biomarker discovery approaches and contributed to the limited therapeutic progress over the past four decades.

Adolescent and young adult patients often fall between pediatric and adult oncology systems, receiving less standardized care and having reduced access to clinical trials compared to their pediatric counterparts. This transition population faces unique challenges in treatment decision-making and long-term care planning.

The rare nature of osteosarcoma limits commercial research investment, while the complexity of the disease has challenged academic research efforts. Data remains fragmented across institutions, preventing the collaborative analysis necessary for meaningful insights in small patient populations.