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Jack Di Palma 2 2021 05 04 184559

USA Health researcher seeks ways to reduce side effects of breast cancer treatment in international study

Gastroenterologist Jack Di Palma, M.D., contributed to a recently published study that aimed to identify ways to manage the diarrheal side effects of chemotherapy.

Published May 4th, 2021

Jack A. Di Palma, M.D., a gastroenterologist at USA Health, is among a group of international researchers that contributed to a recently published study looking for ways to manage the side effects of neratinib, a medication for treating HER2-positive breast cancer.

Diarrhea is a universal side effect of neratinib that, when severe during early treatment, can lead patients to stop using it. When that happens, the drug’s effectiveness is reduced. The goal of the research was to develop ways to manage these side effects so that patients will better tolerate the chemotherapy.

“I proposed some of these strategies to mitigate diarrhea from this class of drugs,” Di Palma said. “I helped design several of the research protocols and am actively investigating a project to better understand why the diarrhea occurs from these drugs. Controlling the diarrhea makes these drugs acceptable and more useful.”

An effective management of the side effect was found by conducting a weekly dose escalation of neratinib at the start of a patient’s therapy. This method helped avoid some of the additional complications that came with incorporating anti-diarrheal medication into patient regimens, and made treatment more tolerable. The implementation of this strategy helps further optimize breast cancer treatment and improve cancer patients’ quality of life.

HER2-positive breast cancer can cause HER2 proteins to overproduce breast cells. It is a more aggressive type of breast cancer than HER2-negative. Between 20 and 30 percent of breast cancers are HER2-positive. There is a 1 in 8 chance that a woman in the United States will experience a breast cancer diagnosis in her lifetime.

The full research publication, titled “Optimal Strategies for Successful Initiation of Neratinib in Patients with HER2-Positive Breast Cancer,” is available to read online at

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