written by Pete Anderson, MD, PhD, pediatric oncologist at Cleveland Clinic and Professor, Department of Pediatrics, School of Medicine at Case Comprehensive Cancer Center at Case Western Reserve University
As Dr. Pete Anderson prepares to retire, we celebrate the incredible legacy of a physician-scientist whose career has bridged clinical care, cutting-edge research, and heartfelt advocacy for children with cancer, especially those facing osteosarcoma.
Throughout his years as a pediatric oncologist at Cleveland Clinic and Professor at Case Western Reserve University, Dr. Anderson has been at the forefront of osteosarcoma research, from investigating lung metastases in the lab to expanding access to care through telemedicine. He’s led by example, advocating for more inclusive clinical trials, guiding families through complex treatment decisions, and encouraging the next generation to think beyond the textbook and never settle for the status quo.
Known for his calm presence, deep compassion, and steady optimism, Dr. Anderson leaves behind not only a remarkable body of work but also a lasting influence on patients, colleagues, and the field at large. As he steps into a new chapter filled with family, outdoor adventures, and continued virtual mentorship, we honor the indelible mark he’s made on pediatric cancer care and research and the osteosarcoma community.
What drew you to osteosarcoma specifically, and what has kept you inspired over the years?
When I was a fellow at the University of Minnesota, I had a patient who needed chemo (early days of chemo) and limb salvage. It worked, and he became a carpenter. Knowing that the major risk of death from osteosarcoma was lung metastases, that inspired me to begin lab work on lung metastases. It has been the unmet need for better treatment of lung and bone metastases that has inspired me over the years.
You've become a national leader in using virtual visits to enhance care and clinical trial access—what sparked that focus, and how do you see telemedicine evolving for pediatric cancer care in the next five to ten years?
Cleveland Clinic was way ahead of the curve on virtual visits. I was encouraged to use them for better access to clinical trials and follow-up in 2016. The virtual visits made me realize that a lot of information and education could be accomplished in a short time using a pre-structured format, like problem solving in the clinic, then sending a summary email + articles. Also, patients were comfortable and open during virtual visits since they were at home; this made the next visit for face-to-face multidisciplinary consultation and/or clinical trial discussions much easier for the family. I see virtual visits evolving to enhance oncology care in many ways in the next 5-10 years, including providing information and education for chemotherapy toxicity reduction, clinical trials, scan interpretation, and helping with sorting out the “majors vs the minors” to have the best outcomes. Hopefully, we will also have easier telemedicine visits because of state licensing compacts as well as encouraging the use of these more often for follow-up and information to save costs and keep patients out of the hospital and reduce complications of cancer therapy (instead of running the same play and getting the same toxic result).
You’ve been a strong advocate for making clinical trials more accessible—how can we continue to break down barriers for families and patients?
The first barrier is providing information in an understandable way to patients and caregivers. I like to think of https://clinicaltrials.gov/ as a starting point. Studies need to have an understandable title (name) that caregivers can search and find the trial, as well as know the rules to get on the trial (eligibility and exclusion criteria). The second barrier is too many rules to get onto a trial. If the rules are too many or too strict, clinical trials may exclude many patients who would be good candidates to benefit. This is especially true of age barriers (most adolescents are adult size and should be included). So instead of having a perfect patient for the trial, we should become more comfortable with less than perfect, for example, age >12 and > 88 lb (40 kg), the size of a little old lady, instead of > 18 yo and having detectable disease instead of “RECIST” criteria. The same is true for less-than-perfect (ok) labs to get on to trials. There should be ways to provide information and education before a face-to-face consult (and a complex consent form) so both families and referring physicians can gain knowledge of what they can do before, during, and after a clinical trial- and know what is possible or not.
You’re known not just for your clinical expertise but for being a steady, calming presence and a source of hope for your patients and families—something textbooks can’t teach. What have your patients taught you over the years that has shaped the way you practice medicine?
What I try to do is look at problems as “opportunities.” Also, pre-planning the visit helps to sort out what is important (and stay calm and on track) when the stakes are high. Instead of our human nature focusing on negatives (“expect the worst”), instead have a positive mindset, “what do you need to do to hope for the best and work towards this.” Pretending you are the patient or parent also helps the discussion.
You’ve always combined deep scientific rigor with out-of-the-box thinking and human connection. How have you managed to strike that balance between innovation and compassion in your day-to-day work with patients and families?
It is important not only to have the best evidence available, but also to know “the art of the possible.” Often, for rare diseases (almost all childhood solid tumors are rare), we do not have randomized, placebo double-blind trials with lots of patients and evidence. Then you need to take a step back and look at the principles of treating solid tumors. Local control is always important, chemotherapy is used to reduce or prevent metastases, and the cancer therapy regimen is meant to help people not just survive but also thrive in ways they never imagined.
In your opinion, what’s the most exciting clinical trial or novel therapy on the horizon for osteosarcoma?
That is a very hard one. For clinical trials, killing off micro metastases better during or after chemotherapy. Mifamurtide was a good example of this. So is the COG cabozanitinib trial. That said, bi-phenotypic monoclonal antibodies (now used not only in ALL, but also small cell lung cancer) may become off-the-shelf agents to get the immune system to be more active in ways with acceptable toxicity. In terms of radiation, I think the alpha-emitting 225-Ac radiopharmaceuticals (e.g., 225-Ac-FAP) have excellent potential as agents to get powerful and focused alpha particles to tumors.
You’re known for encouraging younger oncologists to ‘think outside the box.’ What does that look like in practice?
This means that not being satisfied with running the same play (e.g.,“recipe”) and getting the same result. Instead of one size fits all, learn to cook! (e.g., reduce toxicity, help surgeons and radiation oncologists achieve better results.) Also, “you don’t get smart talking to yourself”- learn from others such as oncology pharmacists, tumor boards, scientific meetings, emails, phone calls, and/or talking with nurses, PAs, and other pediatric and/or medical oncology colleagues.
What’s your advice to the next generation of clinicians and researchers who want to make a difference in rare pediatric cancers?
It is the importance of what we do that should make the difference. Also, I call it the canoe trip mentality - instead of a narrow focus, be ready for new possibilities with each lake and each portage. Enjoy the variety as you get good at what you are doing, and the journey will get better and better. Also, try to do at least one new thing each year - it will help you know that you can make a difference over and over.
As you retire, what are you most excited to spend more time on—whether professionally or personally?
Professionally, being a catalyst for good things to happen using Cleveland Clinic virtual second opinions and virtual visits from Cambridge, MN, to continue helping caregivers with high-quality information and education. Personally, having a reduced schedule to enjoy time doing extra things with my wife, Carol (August 2027 will be our 50th anniversary), and our son’s families, which include 6 grandchildren, such as trips to our Wisconsin log cabin, skiing, kayaking, and canoeing, including BWCAW trips. Finally, I hope to share stories and spend more time with my inspiring 95-year-old mother, Dorie; some days she does more Zoom visits than me!
