Neurotrophin signaling through NGF/TrkA and BDNF/TrkB is increasingly recognized as a driver of osteosarcoma (OS) progression and an organizer of its immune milieu, yet clinical translation has lagged amid intratumoral heterogeneity and a myeloid-skewed, vasculature-aberrant tumor microenvironment (TME). The gene discussed is NGF; the disease is osteosarcoma.