Cancer center director Gustavo Leone reveals his inner rebel

Dr. Gustavo Leone
Dr. Gustavo Leone holds the Grace E. DeWolff Endowed Chair in Medical Oncology. Photo by Emma Vought

When Gustavo Leone, Ph,D., wakes in the morning, the first thought often to cross his mind is, did someone cure cancer today?

The second thought to occur: “Why didn’t I do it?” he says, laughing.

It’s a question that drives him as a researcher and director of Hollings Cancer Center, the state’s only National Cancer Institute-Designated Cancer Center. Since becoming director of the center in March 2017, Leone has focused on recruiting researchers and establishing transdisciplinary teams of clinicians and scientists who can feed off each other’s brain power.

Logistically, this can be challenging as more than 100 Hollings Cancer Center researchers work across 20 academic departments at MUSC, all dedicated to advancing cancer care. The research and insights gained in the lab then need to be translated into the clinic as fast as possible to help the more than 5,000 patients being treated annually at the center. Speeding up this process is one of the center’s top strategic goals.

The cancer center is on a good trajectory, with its clinical arm winning an impressive accolade. MUSC Health was ranked in the top 25 in the nation for cancer care by U.S. News and World Report in 2018. It’s a ranking that brings a smile to his face.

“This is absolutely a tremendous achievement on one hand. On the other hand, I’m not really that surprised. We have fantastic nurses, doctors, oncologists and surgeons who all come together with the same goal and that’s to serve the patient in the best possible way.”

“Everyone had ideals in high school about changing the world – how we can make it a better place. I still have those ideals. ”
– Dr. Gustavo Leone

Leone credits David Mahvi, a surgical oncologist who also serves as chief of the Integrated Center of Clinical Excellence for oncology, for leading the charge in helping the clinical area earn this achievement. “It speaks to the quality of our clinical care and is a recognition of what they do every day,” Leone says. “People at the cancer center should be very proud of that, and people outside the center can know they have a place that’s going to take care of them.”

Leone and Mahvi both are relatively new to Hollings, having joined the cancer center within a year of each other.

“That, together with a number of new recruits and the existing faculty here, has really changed this place into a positive, forward-looking cancer center that is looking at cures — we’re talking about that now — and prevention. That’s definitely on the horizon and that’s good news for the people of South Carolina.”

One case in point: efforts to increase vaccination rates for HPV, the human papillomavirus, which can cause a variety of cancers, including cervical, and head and neck. While it’s an ambitious goal to aim to cure cancer, if it can be prevented in the first place, that’s even better, he says.

In South Carolina, HPV causes more than 580 new cases of cancer each year, and the state has been slow in getting its teens up to the national levels of HPV vaccination rates. Vaccination has been shown to be highly effective in preventing many types of cancer.

“Anything we can do will have a major impact,” Leone says of raising awareness. “HPV vaccination will save thousands of lives in the state. We have to get the word out to the community.”

Engaging the community is critical to Hollings Cancer Center’s effectiveness in the state. South Carolina bears a disproportionate burden of cancer mortality. For all cancers combined, the state ranks 14th in the nation with the highest cancer death rates, according to the National Cancer Institute. Part of the issue is access to care. More than 75 percent of the people in this state live in rural areas. All 46 counties contain areas designated as medically underserved.

No stranger to poverty himself, Leone knows community engagement is one key to finding solutions. “When things get tough or there’s poverty or hardship, people just need to come together. That’s the only way things get done. We need to find ways to inspire people to work together more. We need to use the resources we have to ignite what’s ignitable to have people work together.”

Dr. Leone and his brother, Sergio Leone
Dr. Leone and his brother, Sergio (right), visit Guangxi, China. Photo provided

The early days

Seeing the sophisticated décor of Leone’s historic home on Pitt Street in Charleston, it’s hard to imagine the scrappy boy who grew up on the outskirts of Montevideo, the capital city of Uruguay. Living in a low-income area just a few blocks from a ghetto, Leone shared the one-bedroom, 800 square-foot house with his parents, brother and sister. The floor was a mix of packed dirt and cement, and the only interior door was to the bathroom.

His mom was a seamstress and his father, a computer operator. He got along well with his siblings, mostly because it was the only choice.

“My mom wouldn’t have it. We’d get the strap – well, not the strap, but she’d take her sandals off and chase us around.” Though the family didn’t have much, it didn’t matter. “I loved my childhood. My childhood was awesome.”

He was mostly outdoors, playing soccer until he and his friends wore the ball out, and then they would switch to wooden tops and marbles. “We were very good at marbles. We used to play for real. You played to win, and then you’d keep the marbles. It was vicious.”

Then there was a season for kites. “My dad would always make me a kite – homemade with bamboo. You’d buy the thin, thin paper, and I used to pick the colors, and you folded it with glue that we made with water and flour. It works pretty well unless it rains.”

When he was around 11 years old, the family made a dramatic move to be near family in Montreal, Canada. There he got to experience the thrill of snow. They still lived in a low-income area, but it was a move up.

“The apartment had carpet, so we thought that was pretty spectacular. It was a two-bedroom apartment,” he says. “Coming out of the airport, it was like your eyeballs are coming out of their sockets because of the lights and the complex, sophisticated roads, and the cars seemed like they came out of something like “The Jetsons” – very modern. I had never seen anything like that.”

He didn’t speak English and looked different, so bullying was a problem. “I got into fights almost every day as a child.”

His younger brother, Sergio Leone, remembers how well his brother stood up for him. He’s always had a soft spot for the underdog. Sergio says the one word that best describes Gustavo: passionate.

“When he thinks of something, he just does it. He goes for it. He looked out after me. He always thought of what the right thing was to do,” Sergio says. “He’s always been a good brother to me, and I admire him for all his accomplishments. He’s earned them.”

Those accomplishments included earning money while in school to help the family. Their father died of colon cancer when Leone was 15, so he had to find a way to make more money.

Moving beyond doing yard work and landscaping for a company, he got into refurbishing homes. He remembers getting home at midnight or 1 a.m. He eventually ended up running his own business and hiring others to do projects, earning about $600 to $800 a month.

When the family moved to Calgary, he did a variety of jobs from sandblasting to working in a bottle depot factory. Whatever he did, he did with gusto.

His brother recalls vacationing in Tofino in British Columbia when they noticed a fish thrashing about, trapped by a sandbar. Being teen boys, of course, they decided to catch it. They were running around crazily, catching it, only to have it slide right back out of their hands. Leone paused and suggested a new strategy. They would herd it into a corner, and then he would try a two-handed hold, neck and tail, to see if that worked better.

Soaking wet, Leone took another dive and emerged victorious – arms raised high with a coho salmon glistening in his hands.

“He throws it on the beach and everyone’s clapping,” Sergio says, smiling. “It was an awesome dinner that night.”

Dr. Leone and Dr. Ostrowski
Dr. Leone and Dr. Ostrowski enjoy collaborating on research projects. Photo by Emma Vought

The risk taker

Moving out of his family’s home at 17, Leone felt ready to start his own path. He eventually enrolled in the local university but did horribly. Dropping out, he and his girlfriend Karen decided to hit the road and see the world. “I just wanted to have fun and experience the world.”

He went to Vancouver and did odd jobs, including cooking, as he saved up money to get a motorcycle. He also continued doing martial arts, which he had started at age 13, earning his black belt.

“I figured I should really learn how to fight – not just brawl with one or two people – but really learn how to fight.”

After nine months, he and Karen had saved up enough to get the motorcycle. They went across Canada to her parents’ home in Manitoba to announce they were going on a 14-month road trip across America all the way down to the tip of South America.

They cruised down North America, through the rugged badlands of South Dakota, past the breathtaking wonders of the Grand Canyon and then on to the milder climate of San Diego. There were obstacles, including a hurricane and a bad road accident in Mexico City, where they had to stop to recuperate. They camped out in various places, from beaches to rural farmland, and bathed in rivers.

The couple made it through Peru, Chile and Argentina, and back up through Brazil, managing to squeeze in a crocodile hunting boat expedition on the Amazon River. All they had with them were a few items of clothing, and the whole trip cost just $2,800. The experience profoundly shaped him.

“I learned that everyone is the same in every country. They have the same worries,” he says, adding that the main difference that stood out was between city dwellers and rural people. “The impression was that people are generally beautiful. And I learned that we can go anywhere in the world and be comfortable without Google or maps or plans.”

The hardest challenge for Leone came when he returned to Calgary and had to adjust to a “normal” life. He and Karen married and would go on to have two children during their 14 years together. Leone ran a martial arts school, which kept him in shape and focused when he returned to the University of Calgary. This time he did better and went on to graduate school, where he discovered a new passion.

“I got a call on one Christmas break from a virologist, Dr. Lee, who had some money to support me for the summer. That was awesome. After three weeks of being there, I was cloning genes, and I said, ‘This is what I want to do. This is for me.’”

Dr. Gustavo Leone
Dr. Leone relaxes at his home on Pitt Street, where he often can be found cooking, a favorite pastime. Photo by Emma Vought

The cancer hook

Leone earned his doctoral degree from the University of Calgary and completed a postdoctoral fellowship at Duke University in 1998. “I worked like crazy. I loved the science there. I loved my mentor, Dr. Joseph Nevins. It’s then that I had made the connection between viruses and the mechanisms of cancer. Breakthroughs were happening, and I knew I wanted to work in this area. That was a lot of fun.”

An opportunity arose at The Ohio State University (OSU) as an assistant professor at OSU’s James Comprehensive Cancer Center, a National Cancer Institute-Designated Cancer Center. There was a pioneering atmosphere there because the cancer center had just started recruiting 12 researchers to strengthen its program and start changing the landscape. Leone was one of those recruits.

“It was a big group doing a lot of good science. There was a lot of good camaraderie. We made it into a very good cancer center.”

Hollings Cancer Center researcher Michael Ostrowski, Ph.D., met Leone in 1999 when he also was at OSU. He was involved in Leone’s recruitment to Ohio State following his postdoctoral studies at Duke.

“He is an internationally recognized expert in two fields, cell cycle research and tumor microenvironment,” Ostrowski says. “He is an outstanding colleague and collaborator to many investigators, including myself. His work is recognized as being highly innovative. He is at the cutting edge of discovery research. He is also known as an outstanding mentor.”

They worked on many projects together, bonding. Ostrowski says he found him to be trustworthy, dependable and compassionate, all the characteristics important in a friendship.

“We had colleagues who were a married couple at Ohio State. The wife developed breast cancer and survived. The husband subsequently developed a brain tumor and did not. Gustavo was a true friend to both of them through the ordeal, providing important support for both through the difficult times.”

He also remembers how Leone would host lab meetings - pizza sessions every other Friday evening for more than 20 Ohio State undergraduate students. “It showed his dedication as a mentor and his incredible

On a roll

In many ways, Leone hasn’t changed much from his early years. He doesn’t own a car, he only just recently bought a TV, and he still likes to get some of his clothes from a secondhand store. Other character traits he still carries with him: loving a fight for the underdog and welcoming risks for a good cause.

That’s part of what drew him to Hollings Cancer Center in 2017. Given that the cancer center is the state’s only NCI-Designated Cancer Center, he knew any initiatives he could accomplish would make a big impact.

“Everyone had ideals in high school about changing the world – how we can make it a better place. I still have those ideals. Being the director is an amazing position to be in that allows us to have a positive impact on the world,” he says.

He tries to remain as involved as he can in research despite his larger administrative role. “That for me is energizing. On Tuesday, I can forget about everything else and totally immerse myself in the lab. It feels so good. In the end, I know that science will rule and I have to do more of  that kind of deep thinking because it also influences how I make decisions at the cancer center.”

A leading researcher in the field of transcription factors – figuring out how proteins that regulate gene expression work - Leone says it lays essential groundwork for other studies. “These experiments need to be done – otherwise we’re walking on eggshells for the next 10 to 15 years. Researchers think they know what these proteins do. I want to know when and where they are expressed in the entire body throughout development. It’s a framework for everything else.”

Another important goal for him is to establish a structural biology program with cryo-electron microscopy to help to attract and retain top-tier researchers. The technology can produce accurate, detailed 3-D models of intricate biological structures at the sub-cellular and molecular scales. The models can reveal interactions that were impossible to visualize previously, an ability that is changing the whole field of research in a profound way, he says.

Leone likes to push the envelope. It’s one reason he plans to adopt a cancer fundraising event that’s been remarkably successful at OSU.

Hollings Cancer Center will host Lowvelo in November 2019. The outdoor bike ride, modeled on OSU’s Pelotonia, will offer cyclists three routes: a 25, 50 or 100-mile course. The goal is to land sponsorships to cover the cost of the ride so 100 percent of all rider-raised funds goes directly to support cancer research. The goal the first year is to have 1,000 riders raise $1.5 million. In five years, the goal is 5,000 to 6,000 riders raising $10 million.

Leone admits it’s ambitious. “It can work. And it lets the public know there is a cancer center, and all the amazing work happening here. It’s worth taking the risk.”

What Leone really loves about the ride is that it allows the community to partner with the cancer center, creating a culture of wellness as everyone bonds in the mission to cure cancer. Leone recently spoke at the 2018 LevelUp Convocation of the seventh district of the African-Methodist-Episcopal Church, celebrating a partnership with the group and the cancer center.

The center will be offering its Movenup program that trains community health educators about cancer prevention, screening and treatment options, and the vital role clinical trials play in developing new, more effective approaches to prevent, diagnose and treat cancer.

It dovetails perfectly with the center’s goals to reduce health disparities in the state and to better reach medically underserved areas. A positive spinoff is that many of the churches are interested in sponsoring riders for Lowvelo and want to learn more about healthier lifestyles. It’s a win-win situation.

“This kind of outreach allows us to do something bigger than we can do on our own,” he says.

“By reaching out to communities and asking them to ride and get healthy, you can talk about things that matter to them - nutrition, health, exercise, cancer prevention and screening. Some will want to participate in clinical trials because of this. We’re building relationships and developing trust.”

Though the bike ride offers an impressive athletic challenge for the longer courses, it’s really not about bragging rights. It’s about the community drawing together to be part of the solution to curing cancer, and the cancer center doing more to educate the public about what they can do to prevent cancer and have access to the best treatments.

This is no small feat. Cancer is among the leading causes of death worldwide. In 2018, an estimated 1.7 million new cases of cancer were diagnosed in the nation. Worldwide, the number of new cancer cases per year is expected to rise to 23.6 million by 2030, according to the National Institutes of Health.

That’s not OK to Leone, who would like to see cancer affect fewer lives.

“It’s something we all have a common interest in and that, in and of itself, is beautiful. I like hard work, and I like sweating. I like the fact that you get there, and if you get there with someone else, it’s really nice. It’s a challenge, but it’s doable, and it’s going to help us accomplish great things – individually and as a group.”