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Ian E. Smith, MD, FRCP, FRCPE

The Royal Marsden Hospital
London, United Kingdom

Titles and Affiliations

Professor of Cancer Medicine
Head of the Breast Unit

Research area

Developing new strategies to prevent resistance to estrogen-targeted therapies.


The majority of breast cancers depend on estrogen for growth and are called estrogen receptor (ER)-positive. Inhibiting the production of estrogens or blocking their effect with anti-estrogen agents (such as an aromatase inhibitor or tamoxifen) markedly reduces growth of ER-positive breast cancers—these agents can reduce the chance of death by 30 to 40 percent. It is critical to determine which patients have a good chance of benefiting from these therapies and those that do not. Drs. Smith and Dowsett are conducting studies to define the immune features of those tumors that become resistant to endocrine therapy. This will help to inform treatment decisions and improve outcomes for patients.

What’s next

Drs. Smith and Dowsett have found that multiple signals from immune components of the tumor microenvironment are essential for continued tumor growth. They are characterizing those immune features and will seek to specifically identify those associated with resistance to aromatase inhibitors. They will also determine if new immunotherapy drugs could be used to reverse that resistance and enhance outcomes for patients with ER-positive breast cancer, or those that should be avoided because they enhance resistance.


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 (UK Principal Investigator) for several international multicenter breast cancer trials involving 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.

BCRF Investigator Since


Areas of Focus

Treatment Tumor Biology


Mitch Dowsett, MD, FRCP, FRCPE

The Royal Marsden Hospital and Institute of Cancer Research
London, United Kingdom