From “default dead” to living the future of cancer care As founding CEO of GitLab, I went “founder mode” on my osteosarcoma - The Cancer Letter Skip to navigation Skip to content
Search for:
The Cancer Letter on Facebook<br>The Cancer Letter on Twitter<br>The Cancer Letter on LinkedIn
The Cancer Letter<br>The leading source for information on the issues that shape oncology since 1973
Guest Editorial
From “default dead” to living the future of cancer care
As founding CEO of GitLab, I went “founder mode” on my osteosarcoma
August 14, 2026<br>Vol.52 No.32
Share on facebook
Share on twitter
Share on linkedin
Share on email
Share on print
BYLINE
IN THIS ISSUE
BYLINEDOWNLOAD PDFTABLE OF CONTENTS
In November 2022, I was 43 years old, healthy, active, and the founding CEO of the publicly traded tech company GitLab.
I was doing a bench press when I felt a strange pain near my chest. I’d felt something like it before and it had passed. This time it didn’t. Two weeks later, unable to sleep at 4 a.m., I drove to the emergency room. The doctors found nothing on the X-ray and sent me home.<br>A few hours later, my GP called and asked if I knew how to meditate. I said yes. He told me to start immediately, because I might be having an aortic aneurysm and the pain could be my aorta starting to burst. I went back to the ER. My aorta was fine, but the scan found something else: a six-centimeter tumor growing out of my vertebrae.<br>The diagnosis was high-grade osteosarcoma of the thoracic spine.<br>What follows is my story through treatment, remission, recurrence, and into the fight for survival once the standard of care had been depleted. That fight required developing a new, fully personalized paradigm for my own treatment, one that I’m proud to say has resulted in me being measurably disease-free for over a year.<br>Mine is an n=1 case, but I believe it points to a possible future that can and should be more broadly accessible.
In the beginning
After my diagnosis, my team treated the cancer aggressively. I had surgery to remove the mass, a spinal fusion, radiation, and multiple rounds of chemotherapy so intensive that I required four blood transfusions.<br>During that same stretch of treatment, I got my first glimpse of what exists beyond standard of care. Years earlier, through Y Combinator, the famed startup accelerator, I’d become friends with Jose Mejía Oneto, MD, PhD, the CEO and founder of Shasqi. He was working on applying click chemistry to medicine. The vision was and continues to be to enable drugs to be active at the right location in the body, in order to limit off-target toxicity and maximize efficacy of drugs. Biotech investors were skeptical of the approach, but I believed, and became its largest investor.<br>Sijbrandij and Dr. Jose Mejía Oneto together as Sijbrandij receives a Shasqi drug under single-patient IND.<br>When I was diagnosed, Jose and my oncologist determined that the targeted chemotherapy his company was developing was a viable treatment option for me, but access looked nearly impossible. The clinical trial had already closed, and everyone told us the FDA route would be too slow. It wasn’t. We filed a single-patient IND, and it moved quickly.<br>Our roles quietly reversed. I had spent years helping keep Jose’s company alive. Now he was helping keep me alive. The combination of standard of care and the Shasqi therapy put my cancer into a remission that lasted about a year.<br>Then the cancer came back. It progressed locally, and there were no more standard of care therapies with extensive evidence behind them. My oncologist, whom I respect tremendously, told me he had nothing left he could recommend.<br>He suggested I look for a clinical trial. Osteosarcoma is rare, particularly in adults, and there were none that fit. Standard of care had run its course.
Going “founder mode” on my cancer<br>Paul Graham, who founded Y Combinator and who has spent decades thinking about what separates startups that survive from those that don’t, coined the term “default dead” to describe a startup that, at its current rate of spending and growth, will run out of money before it reaches a point where it can sustain itself.<br>When I ran out of standard of care, I was “default dead” in the most literal sense there is. My runway of options was at an end, and if nothing else changed, I was going to die.<br>But Graham has another essay, detailing a set of behaviors he calls “founder mode.” While a person operating in “manager mode” will delegate decisions to their team and trust in established processes to surface the right answers, “founder mode” requires diving in directly, getting into the details, staying close to the information, and making decisions at the pace the situation requires.<br>Sijbrandij receives the first dose of a personalized mRNA vaccine at Houston Methodist Hospital.<br>In a piece published earlier this...