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Ian E. Smith, MD, FRCP, FRCPE
Professor of Cancer Medicine,
The Royal Marsden Hospital and Institute of Cancer Research
Head of the Breast Unit, The Royal Marsden Hospital
London, United Kingdom
Estrogen receptor-positive (ER+) breast cancer makes up more than two-thirds of all breast cancer cases, particularly those that occur after menopause. Although a variety of successful anti-estrogen drugs are available to treat ER+ cancer, resistance to these therapies remains a significant clinical challenge.
Drs. Smith and Dowsett are using new a new clinical trial platform called POETIC-2 (PeriOperative Endocrine Therapy for Individualized Care-2) to identify potential combinations of anti-estrogen drugs and other drugs that target anticipated resistance mechanisms in individual patients. Patients who are diagnosis with early-stage ER+ breast cancer are asked to take an aromatase inhibitor (AI) for four weeks. If after that time, their tumor continues to show signs of growth, another drug is administered to block that growth.
This year, the team is conducting four separate associated studies within the POETIC-2 cohort (i) confirm that gene expression signatures of endocrine resistance are enriched in residual disease after neoadjuvant AI treatment; (ii) investigate if tumor DNA alterations are contributing to this resistance; (iii) separate proliferative (actively growing) from non-proliferative breast cancers and compare the DNA alterations between the two groups; (iv) validate the robustness of the proliferation marker that is used as an entry criterion for POETIC-2 and to assess tumor response to treatment.
These studies will improve our knowledge of the characteristics of an individual's tumor and offer the potential for individualized therapy and new drug development.
Ian E. Smith, MD, FRCP, FRCPE, is Professor of Cancer Medicine at The Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom. He is also Head of the Breast Unit at The Royal Marsden Hospital.
His initial medical training was in Edinburgh and he came to the Royal Marsden, London, for specialist training in cancer medicine. He spent some time in Boston at the Dana-Farber Cancer Institute, Harvard. His principal clinical research interests have been in breast cancer, lung cancer, and in new drug development. He was involved in the early clinical development of several anticancer drugs that have subsequently proved effective in the clinic, including carboplatin and letrozole. In the last decade he has become increasingly involved in neoadjuvant therapies as a research approach towards individualizing treatment for breast cancer. He is currently Chief Investigator or UK Principal Investigator for several international multicenter breast cancer trials involving in particular targeted therapies and aromatase inhibitors. He publishes and lectures extensively. He was awarded the Susan G Komen for the Cure Brinker Award for Scientific Distinction at the 2009 San Antonio International Breast Cancer Conference.
Professor Smith is Co –Chairman of the ASCO Clinical Guidelines Group for Chemotherapy in Metastatic Breast Cancer, and has just been appointed the first Chair of the newly formed UK Breast Cancer Clinical Reference Group. He is a patron of Breast Cancer Care, the largest UK breast charity for patient support.