# Hepatotoxicity (liver enzyme elevation)

Source: https://onco.cc/terms/hepatotoxicity/  
OnCo record `hepatotoxicity` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Liver injury from a drug, usually detected as a rise in liver enzymes (ALT, AST) on routine blood tests before symptoms appear. Most cases settle with a pause or dose reduction; a few, especially with checkpoint inhibitors or in already damaged livers, are serious.

## Summary

Kinase inhibitors (pazopanib, lapatinib, several ALK and ROS1 inhibitors), immune checkpoint inhibitors (immune hepatitis, treated with steroids), ADCs with calicheamicin payloads (inotuzumab, gemtuzumab: veno-occlusive disease especially around transplant), methotrexate, and CAR-T all cause hepatotoxicity, graded by ALT/AST and bilirubin multiples of normal. Pre-existing cirrhosis narrows the margin in liver cancer, hepatitis B can reactivate under rituximab and chemotherapy (screen and give antivirals), and Hy's law (ALT >3× with bilirubin >2×) predicts severe injury and can end drug development. Liver function tests are checked before every cycle of most regimens.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: liver toxicity; hepatic toxicity; hepatotoxic; transaminitis; transaminase elevation; elevated transaminases; raised liver enzymes; liver enzymes; ALT/AST; liver function tests; LFTs; drug-induced liver injury; DILI; immune hepatitis; immune-mediated hepatitis; hepatitis B reactivation; HBV reactivation; veno-occlusive disease; sinusoidal obstruction syndrome; VOD/SOS; hyperbilirubinaemia; liver enzyme

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Hepatotoxicity
- Wikipedia: https://en.wikipedia.org/wiki/Hepatotoxicity

## Connected records

- terms: [Child-Pugh score](https://onco.cc/terms/child-pugh/), [Cirrhosis](https://onco.cc/terms/cirrhosis/), [Dose reduction, interruption and discontinuation](https://onco.cc/terms/dose-modification/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Fenbendazole (veterinary anthelmintic)](https://onco.cc/drugs/fenbendazole/), [Ivermectin](https://onco.cc/drugs/ivermectin/)
- key papers: [Drug-induced liver injury following co-ingestion of veterinary fenbendazole and ivermectin for prostate cancer: a case report](https://onco.cc/key-papers/paper-powderly-fenbendazole-ivermectin-liver-injury-2026/), [Severe drug-induced liver injury due to self-administration of the veterinary anthelmintic medication fenbendazole](https://onco.cc/key-papers/paper-thakurdesai-fenbendazole-liver-injury-2024/)
- cancers: [HER2-mutant non-small-cell lung cancer](https://onco.cc/cancers/her2-mutant-nsclc/), [KRAS G12C-mutant non-small-cell lung cancer](https://onco.cc/cancers/kras-g12c-nsclc/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/)
- trials: [Beamion LUNG-1](https://onco.cc/trials/beamion-lung-1/)

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