ROLE OF ANTI-HISTAMINE IN COLORECTAL CANCER
Colorectal cancer is a disease where the healthy lining of the rectum or
colon spreads out of control afterward it forms a tumor, and this growth
is called a polyp. Colorectal cancer is one of the primary causes of
cancer-related mortality in the world . CRC is accountable for more than
600,000 mortality yearly and occurrence rates are rising mainly in the
advancing nations. Epidemiological, as well as laboratory surveys,
suggest that environmental factors such as western style dietary habits,
tobacco smoking, and absence of physical actions are measured as risks
for CRC. The molecular pathology of CRC involves pro-inflammatory
conditions to stimulate the tumor’s malignant progression, and attack in
addition to metastasis . It is well-identified that patients with IBD
are at greater risk of CRC. Infection involves relations between
countless immune cells, inflammatory cells, chemokines, cytokines, and
pro-inflammatory mediators which may lead to signaling regarding tumor
cell proliferation also attack . An article published online on January
2011 stated that the third-generation compound oxaliplatin is the key
agent for the management of colorectal cancer. When Patients were
treated with Oxaliplatin it caused hypersensitivity reactions.
Hypersensitivity reaction to Oxaliplatin developed one of the followings
symptoms and was considered a manifestation of a severe allergic
reaction like pulmonary erythema, Urticaria, tachycardia, angina,
wheezing, facial or tongue edema, Dypsenea hypertension, Hypotension,
respiratory arrest, diffuse erythroderma, anaphylaxis, seizure or death.
So they conducted a retrospective cohort study of patients having
advanced colorectal cancer who received modified FOLFOX 6 . A
premedication routine was given to the patients with dexamethasone 8 mg
and Granisetron 3 mg for the first five cycles of FOLFOX 6. Cohort 1
received the first pre-medication from the sixth cycle. Cohort 2
received a modified version of premedication i.e. diphenhydramine 50mg
orally, followed by granisetron 3 mg, dexamethasone 20 mg and famotidine
20 mg. The researcher’s then compared the incidence of hypersensitivity
reactions, duration of the treatment and reasons for treatment
withdrawal between two cohort studies . A total of 181 patients were
studied in the cohort, they found out that in cohort one 16 patients
developed hypersensitivity reactions (20%) and in cohort two 7 patients
developed hypersensitivity reactions (7.0%). In cohort one other than a
progressive disease, they discontinued the treatment in 20% of patients
due to neurotoxicity as compared to cohort two . It was concluded that
high doses of dexamethasone and antihistamine remarkably decrease
Oxaliplatin related hypersensitivity reactions . So this effective
approach should be considered for all patients receiving FOLFOX . A
randomized phase II clinical trial was conducted to study the effect of
the given drug Levocetirizine on patients having colorectal cancer and
how it affects the tumour response to Capecitabine and bevacizumab . The
second-generation drug H1 antihistamine Levocetirizine with
anti-inflammatory and IL-8 suppression properties. A chemotherapy drug
Capecitabine blocks tumour growth by disrupting the DNA- RNA synthesis
and restoring cell division. On the other hand, the monoclonal antibody
bevacizumab blocks tumour growth by inhibiting the growth of blood
vessels that feed those. Patients having colorectal cancer may develop
resistance towards the bevacizumab effects. To overcome the
anti-angiogenic therapy resistance 47 patients volunteered in the trial.
Arm A volunteered 23 patients, where Levocetirizine was started after
starting the chemotherapy. Arm B volunteered twenty-four patients, where
Levocetirizine was started prior to the chemotherapy. In arm, A median
time progression was 3.4 months whereas in arm B it was 3.5 months. It
was then concluded that 50% of the patients had progressive disease and
62% of patients had stable disease in both arms as a great response.
There was no provable difference between the two arms, but patients with
the stable disease showed a decreased level of IL-8 as compared to the
patients with the progressive disease in the analysis of cytokine .