The video (above) was taped in 2018.
As a boy growing up in Schenectady, New York, Steven Patierno, PhD, could often be found out in the woods performing surgery on frogs, when he wasn’t playing sandlot soccer or a local, slightly more “aggressive” version of capture the flag.
“I always knew I wanted to be a scientist, even before I knew what a scientist was,” shares the deputy director of Duke Cancer Institute.
As a teen, he was into marine biology and gradually took up scuba diving — even volunteering with the Woodshole Oceanographic Institute following whales transiting Nantucket Sound.
Once he entered college in the mid-1970s, his scientific interests shifted.
“I became fascinated by how drugs worked in the brain, the science of neuropharmacology,” recalls Patierno, who received his Bachelor of Science degree in Pharmacy at the University of Connecticut in Storrs, Connecticut.
His first-generation Italian parents expected that after their son — the first in his family to go to college — earned his degree, he’d come home and work in a pharmacy like his clean-cut, tie-wearing classmates.
“They thought I’d be the guy in the short white coat behind the counter at CVS,” laughs Patierno. But the self-described “misfit” at pharmacy school, “a rebellious longhair with an earring” whose side hustle was playing keyboard and guitar in a band, “never had any desire to be a pharmacist.” The pharmacy-oriented faculty of the school were also “concerned” – until the Dean introduced him to the research faculty. “It opened up another world,” he shared.
Patierno felt most at home in the lab where more people looked like him and thought like him; “curious and interesting people,” he notes, “who were interested in making discoveries and moving science forward, not just owning a drugstore.”
After graduation and some time off to think about what was next, he would leave the northeast for the University of Texas Health Science Center in Houston to pursue his PhD in neuro-pharmacology.
Transformation
Patierno, at 24 years old, was at the end of his first year at the Graduate School of Biomedical Science, when he decided to attend a highly advertised seminar across the street at Baylor University.
He remembers the transformative moment as if it were yesterday. It was 1982.
“I went over to this massive lecture hall and up in the front were what we used to call the “starched white coats” with their suits and ties and grey hair all coiffed — the senior physicians and scientists who ran the place,” remembers Patierno, drawing a contrast with his chosen “uniform” of the day — torn jeans, clogs, and a Grateful Dead shirt.
He continues: “They were raving about this new technology that was going to transform the world. Finally they called Richard Palmiter to the stage. He’s got a gray ponytail down to the center of his rear end and he’s wearing jeans and a rock-n-roll t-shirt, like me. I still remember it to this day. He gets up and ambles over to the microphone and delivers this mind-blowing lecture. By the end, I looked at him and decided then and there, That’s what I want to do.”
Palmiter and his research partner Ralph Brinster, VMD, PhD, Patierno explains, had just produced the first “transgenic” mice expressing cloned human cancer genes. He was inspired.
After chatting with Palmiter after the lecture, he walked straight to the department chair’s office and requested to change his focus from to neuro to cancer pharmacology.
“He was mad, mad, mad at me,” says Patierno.
Three years later he defended his thesis on chemical carcinogenesis and DNA damage, married his girlfriend (a Texas-born cardiology nurse) and left Texas for an NIH-funded postdoctoral fellowship in molecular oncology and carcinogenesis at the University of Southern California (USC) Norris Comprehensive Cancer Center.
Two-and-a-half years in, and itching to run his own lab, he accepted a faculty position with the Department of Pharmacology at George Washington University (GWU) in Washington, D.C. They were looking to hire a molecular biologist who could clone genes and study gene regulation. “Back then there just weren’t many of us who knew how do this kind of work,” he recalls.
His lab at GWU had two areas of focus: half the lab worked on the molecular basis for chemical carcinogenesis and the other half focused on disease-oriented drug discovery, specifically in the context of breast cancer and prostate cancer. Grants began to roll in and he built a “lab army”: at one point he had nine post-doctoral fellows, seven grad students and multiple technicians.
In 1995, Patierno was tapped to lead GWU’s Cancer Research Center, and in 2002, was offered the job of founding executive director of the new GW Cancer Center.
A Vision
Patierno wouldn’t accept the directorship, however, without support for his expansive and expensive vision to address the “shocking health disparities” he’d witnessed in inner-city Washington D.C. as a volunteer on weekends ministering to the poor, the homeless, drug addicts and HIV patients.
Half the patients walking through the GW Cancer Center doors were from the impoverished quadrants of the city, where there were very few available health services.
“Like most cancer centers, we were functioning as an ivory tower, expecting the patients to come to us and not really engaging with them in their communities,” he explains.
To his surprise, he got the job with the “startup package” for his vision, which included deploying a mammography van, conducting prostate cancer screenings in the community, conducting a neighborhood-by-neighborhood cancer education campaign, encouraging more minorities to participate in clinical trials, and eventually collaborating with the DC city government to turn an NCI-funded patient navigation research program (which connected patients with five major area cancer centers and multiple clinics and advocacy organizations) into a giant cancer safety net for the underserved.
Meanwhile, Patierno’s lab had begun to uncover evidence that even after removing the social and structural determinants that contribute to cancer disparities, there was still a mortality difference between African Americans and Caucasians, particularly as it relates to prostate and breast cancer.
With supplemental funding from the NCI, he and his collaborator Norman Lee, PhD, began looking into the biological underpinnings — the genomics of cancer disparities. The early results were intriguing enough for Patierno to turn over his carcinogenesis grants to young faculty he had mentored; steering his entire lab into studying the biology of cancer disparities.
Pulling Up Stakes
Patierno says he was drawn to Duke Cancer Institute because of its “powerhouse research,” “the chance to mold and shape a new cancer institute, from the ground up,” and the opportunity to work closely with Michael Kastan, MD, PhD, a molecular biologist and director of St. Jude Children’s Research Hospital Cancer Center; a professional colleague who was simultaneously being recruited to Duke.
Once at DCI, Kastan and Patierno launched the Office of Health Equity (OHE), whose mission it is to reduce cancer disparities and improve population health in the region for African American (25 percent of Duke’s cancer patient population), LatinX, Asian, Native American, Jewish, Muslim, LGBTQ+, and rural communities. OHE partnered with the community to form a diverse 20-plus member Community Advisory Council made up of leaders who understand the cancer health needs within DCI’s catchment area. Nadine Barrett, PhD, was recruited as OHE’s first director.
“OHE staff members worked tirelessly in the DCI’s local community, sponsoring and organizing numerous community health education and cancer screening events and building an extraordinary community-facing patient navigation program,” notes Patierno. “At the end of 2018, they launched DCI’s Just Ask Program, which aims to boost participation of patients from minoritized/marginalized communities in cancer research by educating the health system about barriers and the community about the benefits of clinical trials.”
“The marked lack of diversity in clinical research across the nation is one of the largest challenges that researchers face,” he adds.
In January 2019, the V Foundation gave the program a $71,000 boost and the Just Ask Program has now gone national, endorsed by several major cancer research and advocacy organizations.
In 2019, with Barrett’s national profile growing, Patierno hired U.S. Army Lieutenant Colonel (ret.) Angelo Moore, PhD, RN, to run and expand the extensive and growing grassroots community outreach programs. In early 2021 he brought social and molecular cancer epidemiologist Tomi Akinyemiju, PhD on board to oversee vision and strategy and work collaboratively with cancer scientists to ensure that DCI is improving health outcomes for all the patients it serves.
Over the past two years, new patient navigators, administrative staff and research staff, including a biostatistician, have also been hired to boost capacity and make good on DCI’s commitment to ensuring better access to cancer education, screenings, and clinical trials in the community it serves.
With an expansion of staff and mission, the Office of Health Equity was in 2021 renamed COEE — DCI Community Outreach, Engagement, and Equity. Akinyemiju was named associate director for COEE and Moore was named assistant director.
Paradigm Shift
Duke Cancer Institute’s Patierno/George/Freedman lab is led by Steve Patierno, PhD, Jennifer Freedman, PhD, and Daniel George, MD.
Patierno’s lab at Duke — the nine-person Patierno/George/Freedman Lab — focuses on what he calls the “omics” of cancer disparities, including genomics (DNA), transcriptomics (gene expression at the RNA level), proteomics (gene expression at the protein level), metabolomics (metabolic pathways), and epigenomics (modifications in the genetics of a cell).
Having started with prostate cancer, the lab’s disparities research has since expanded into breast, lung, and liver cancer and attracts millions in research funding.
Patierno was principal investigator to a specialized Exploratory Grant (P20) from the National Cancer Institute linking NCI-designated Comprehensive Cancer Centers to Historically Black Colleges and Universities. Partnering with Duke’s neighbor in Durham, North Carolina Central University, Patierno co-led the Duke-NCCU Translational Cancer Disparities Research Partnership. This program included two research programs on breast and prostate cancer disparities and an educational program focused on training under-represented minority (URM) graduate students and postdoctoral fellows.
Patierno is currently the PI on a $3.5 million Exploratory SPORE grant from the National Cancer Institute to support ongoing research projects in lung, stomach, breast, and head and neck cancer disparities and DCI’s investment in a multidisciplinary program of translational research and education in cancer health disparities.
In October 2021, he was awarded, together with lab co-leader Jennifer Freedman, PhD, and Katherine Hoadley, PhD (UNC Lineberger Comprehensive Cancer Center), a $500K three-year Susan G. Komen and Blue Cross NC Metastatic Breast Cancer Disparities Collaborative Research Grant. They are seeking to identify how differences in RNA splicing and immune system characteristics in metastatic breast cancer patients of African versus European ancestry impact the growth and spread of breast cancer.
Patierno says RNA splicing differences “offer a potentially rich opportunity for reducing disparities and improving treatment for multiple cancers in all patients.”
“In studying ancestry-related differences in RNA regulation, our research team has discovered large numbers of splicing alterations that drive the aggressive biology of invasive cancer,” he explains. “Some of these splice variants are druggable and are under pre-clinical development as potential new targets for treatment.”
Ever Inspired
in February 2018, when Patierno was honored by the Duke Office for Institutional Equity with an Equity, Diversity and Inclusion (EDI) Award, Kastan said, “Dr. Patierno is an internationally recognized expert in cancer control and his research laboratory has enjoyed uninterrupted funding from the NIH for more than 30 years. His work has had, and continues to have, a far-reaching impact on cancer health disparities.”
Patierno continues to play a key role in cancer health disparities on the national stage. In 2018, he keynoted the NCI “ThankTank on Cancer Disparities” and in 2019, he was awarded the American Association for Cancer Research Distinguished Cancer Disparities Research Scientist Award.
He went on to co-chair and keynote the AACR’s 2020 Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved and was tapped by AACR to co-chair a large national committee responsible for producing the 2022 AACR Cancer Disparities Progress Report. In March 2022, he co-chaired the American Society for Preventative Oncology annual conference —this year themed: “Towards Achieving Cancer Health Equity.”
Patierno notes that the COVID-19 pandemic has shined a spotlight on health disparities in a way that adds new urgency to all this work. “We’re right at the apex of changing the world right now,” he says, “eliminating cancer disparities with the goal of achieving health equity.”
At age 63, Patierno is still energized and inspired by the patients he serves.
His Duke Cancer story — the culmination of a life’s work in the field — is far from finished.
This is an updated version of an article that was originally published on the Duke Cancer Institute blog in 2018. The video at the top of the page was taped in 2018.
