When St. Luke’s medical oncologist Neil Belman, DO, began treating patients 27 years ago, cancer treatment was one size fits all. Treatment today has evolved to “small, medium and large.”

In the future, he anticipates it will be like a tailored garment created to fit the individual patient exactly.

“We knew several decades ago that cancers, which looked similar under the microscope, weren’t identical,” said Dr. Belman of St. Luke’s Hematology Oncology Specialists - Coaldale. “Then, when you had 100 patients with colon cancer, oncologists would treat all of them with chemotherapy; 30% would get better, 20% would stabilize and 50% would get worse.”

Now, we know cancer is not one disease but hundreds of different diseases, he explained. It is caused by a combination of factors that align in the wrong way. Factors include nutrition, environmental exposure to cancer-causing substances, hormone malfunctions, infections and genetics.

“Cancer is not a monster or another country invading ours,” he said. “It’s a problem to be taken care of one way or another. That’s an important starting point.”

Finding the right treatment

When Dr. Belman meets with a patient newly diagnosed with cancer, he explains their type of cancer, treatment options and side effects.

Together, they create a plan to cure the cancer with the least harm. If the cancer is not curable, their goal is to extend life while optimizing quality of life. Fortunately, great strides have been made.

“Of the medicines I have in my toolbox today, 70% were not available when I finished my training,” he said. “With the development of each new medication, some incremental benefit occurs. Either they keep the cancer under control longer, increase the cure rate by another 2 or 3%, or they perform similarly to an existing drug, but with less side effects.”

These small changes chip away at beating cancer, improving the patient’s prognosis.

“A 3% increase sounds meager, but remember those are three human beings who now are living longer or not having a recurrence of their cancer. That’s your friend, your cousin. At the end of the day, if it’s someone you love, that matters.”

The five-year survival rate of non-small cell lung cancer was below 5% just 10 years ago. That means of 100 people diagnosed with the disease, only 5% were alive five years later. With the use of immunotherapy drugs and other advances, the long-term survival rate has increased to 25-30%, according to data released this year.

“I know that’s not 100%, but 25-30%, compared to 5%, is a big change,” he said. Two months or two years from now, some other medicine or treatment comes available and it’s another 2 or 5% increase.

Using your DNA to fight

Immunotherapy - also called personalized cancer medicine, molecular testing, mutational testing, next generation sequencing and DNA-based therapy - has greatly improved treatment for certain types of cancer.

Immunotherapy looks for mutations in the cancer cell called driver mutations. They contribute to cancer cell growth and can be targeted with specialized medications that slow or stop the growth more effectively than chemotherapy alone.

In lung cancer treatment, there’s a drug that targets a EFGR mutation. When given to a patient after surgical removal of a tumor, it decreases the risk the cancer will return by 20%.

Unfortunately, only a small percentage of lung cancer patients have this mutation, he said.

Continued improvements

Over the next 50 years, cancer research will become personalized. Oncologists will create treatment plans based on individual anatomy, the presence of other diseases/health conditions, health history and lifestyle factors.

These include occupation, exercise habits, diet and alcohol, drug and tobacco use. By understanding how these factors interact, oncologists will be able to truly tailor treatment to the individual, he said.

Dr. Belman is fascinated by the “cancer puzzle.” The current speed of advances makes it an exciting time to be an oncologist. But he also appreciates the opportunity to develop relationships with his patients.

“My job has helped me live a fuller life,” he said. “Life is for helping other people. If you achieve that and you’ve progressed your mind from learning from others, you’ve benefitted yourself and others, and lived a fuller life.”

To make an appointment with Dr. Belman at St. Luke’s Hematology Oncology Specialists - Coaldale, call 484-503-4673.