CTSI Spotlight: Joel Palefsky

Joel Palefsky, MD

Joel Palefsky, MD, is the director of the Clinical and Translational Research Fellowship Program (CTRFP) at CTSI. Note: Dr. Palefsky was recently awarded an $89 million grant from the National Cancer Institute for a major investigation of anal cancer.

How long have you worked at UCSF?

I’ve been at UCSF since 1989, nearly 25 years now.

What do you do at UCSF and how is it connected to the UCSF mission?

Like most faculty, my work at UCSF has several different components.  I like to think that I personify the cross-disciplinary, team-based clinical and translational research approach for which UCSF is so well known.  I have a basic science lab in which I and my very talented colleagues investigate the molecular pathogenesis of DNA tumor viruses such as human papillomavirus (HPV) and Epstein Barr virus (EBV).  We’re focused on their role in diseases of epithelial cells, such as cervical cancer, anal cancer, and oropharyngeal cancer ,and trying to develop novel therapies for these diseases.  On the clinical end of the spectrum, I founded and direct the UCSF Anal Neoplasia Clinic where I see patients.  And in the middle of the spectrum, I direct a talented multidisciplinary team of clinical researchers focused on testing new therapies for HPV-related diseases and preventing anal cancer through primary prevention (vaccination) and secondary prevention (screening and treatment of cancer precursor lesions).  All of these efforts are closely tied together and feed each other.  Clinical samples from the Anal Neoplasia Clinic and the research clinic make their way into my lab.  Work in the lab has generated important clinical and clinical research questions.  

Another passion of mine is training young pre-doctoral researchers from all four UCSF schools in clinical and translational research and engaging them early in their careers.  Our goal is to stimulate them to continue their training as they advance, and continue to become lifelong researchers/ learners in their careers.  To this end, I direct the CTSI’s Clinical and Translational Research Fellowship Program which includes the TL1 pre-doctoral student training program and the Doris Duke Charitable Foundation International Clinical Research Fellowship Program.   

I enjoy teaching very much, and I lecture and teach in several courses.  Other teaching activities are also tied closely into the work we do in the Anal Neoplasia Clinic and research clinic.  We train clinicians from all of the world in our clinic in a technique called high resolution anoscopy and give didactic courses in this technique and anal cancer prevention around the country and the world.

Like most faculty I also sit on several committees and UCSF, national and international advisory boards.  I also believe that community/professional service is very important.  I founded and am president of a new professional society, the International Anal Neoplasia Society, and am also the president of the International Papillomavirus Society.  

Typical UCSF: I am clinically trained in Infectious Diseases and my primary appointment and laboratory are in the Department of Medicine.  My clinic is part of the Helen Diller Family Comprehensive Cancer Center (HDFCCC).   My clinical research staff is housed at the HDFCCC.  My  first appointment at UCSF was in the Department of Laboratory Medicine and my first laboratory spaces were in the Department of Laboratory Medicine and in the Oral AIDS Center in the School of Dentistry.

What are the most challenging and rewarding parts of your job?

Let’s start with the rewarding parts:  You might guess that I’m never bored!  No two days are the same.  Time on this planet is very short and it is important to me to make it meaningful.  To make my time count and to respond to some of the chaos that I see around us, my goal is to do my part to make things better in my own small way.  There Is no better way to do that than by helping people.  I  like to think that each of the activities in which I am engaged helps people in different ways. UCSF facilitates that. I also get to work with talented, dedicated people with similar goals and who are willing to take chances and be creative.

Inherent in all of this, there are many challenges. Taking chances means that there will be failures.  That is a necessary part of the creative process, but it’s still difficult.  Trying to do more in an environment with shrinking resources is a huge challenge. Bureaucracy. And certainly not least, the work-life balance issue and trying  to make sure that my loved ones receive all the love and attention that they deserve.

What do you like most about your work related to UCSF and beyond?

There is an indescribable thrill to discovery and to creation. I love the feeling that I am spending my time trying to do something to change the world. In my capacity as a teacher/training program director, I love being surrounded by younger people who abound with curiosity, intelligence, energy and optimism. I am fortunate to work in many places around the world and travel is a great privilege. I get to work with terrific like-minded people from different cultures, and we really do form a global community.

What are some things that people may not know about the work you do?

My team and I founded the world’s first clinic devoted to anal cancer prevention, the UCSF Anal Neoplasia Clinic.  In many ways, we are the fathers and mothers of this field.  We are about to embark on the biggest adventure yet: it’s a newly-funded study called the ANCHOR Study, in which we are going to perform the definitive randomized controlled trial to determine whether treatment of anal cancer precursor lesions reduces the incidence of anal cancer in high-risk men and women.  Funded by the National Cancer Institute, the study will enroll over 5,000 men and women at 15 sites around the country.  My team at UCSF is leading the effort. The study is designed to establish standard of care guidelines for prevention of anal cancer. It will also provide us with a unique basic/translational science opportunity.  We will be collecting clinical specimens that will allow us to understand the last steps in the the molecular pathways of progression from pre-cancer to cancer.  We hope to use the information to  identify new treatment approaches to prevent progression to cancer.  It will also allow us to identify new biomarkers that will help us separate those at highest risk of progression to cancer, and who therefore need to have their precancerous  lesion treated, from those who can be safely monitored without treatment.  It’s designed to be an 8-year study, and it will be challenging on many fronts.  

If you chose another career path outside UCSF what would it be?

It’s not something I think much about. 

What's something that your colleagues or members of the UCSF community might be surprised to know about you?

I have a few slightly distinguishing personal characteristics.  I was born and raised in Canada.  I think that infuses my world view. My partner and I are part of a “modern family”- two dads, two moms, and our 17 year old son, a remarkable young man who I am sure will be making his mark as well.

What are your favorite things to do with your free time?

My favorite thing to do with my free time is to engage in activities that are completely “other” from my usual activities.  I love to read fiction and non-fiction.  I love to travel.  Sleep is a very good thing.

CTSI Spotlight is part of an ongoing series that offers an opportunity for faculty and staff to learn more about the wide range of people who make CTSI's work possible. See all featured faculty and staff.