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 .