{"entity":{"id":"hepatotoxicity","kind":"term","name":"Hepatotoxicity (liver enzyme elevation)","aka":["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"],"tldr":"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.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Hepatotoxicity","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Hepatotoxicity"}],"tags":[],"related":["cirrhosis","irae","dose-modification","child-pugh"],"cancers":[],"sections":["supportive-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Side effects"},"route":"/terms/hepatotoxicity/","neighbours":{"term":[{"id":"child-pugh","kind":"term","name":"Child-Pugh score","route":"/terms/child-pugh/"},{"id":"cirrhosis","kind":"term","name":"Cirrhosis","route":"/terms/cirrhosis/"},{"id":"dose-modification","kind":"term","name":"Dose reduction, interruption and discontinuation","route":"/terms/dose-modification/"},{"id":"irae","kind":"term","name":"Immune-related adverse events (irAEs)","route":"/terms/irae/"},{"id":"obstructive-jaundice","kind":"term","name":"Obstructive jaundice and biliary obstruction","route":"/terms/obstructive-jaundice/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"fenbendazole","kind":"drug","name":"Fenbendazole (veterinary anthelmintic)","route":"/drugs/fenbendazole/"},{"id":"ivermectin","kind":"drug","name":"Ivermectin","route":"/drugs/ivermectin/"}],"paper":[{"id":"paper-powderly-fenbendazole-ivermectin-liver-injury-2026","kind":"paper","name":"Drug-induced liver injury following co-ingestion of veterinary fenbendazole and ivermectin for prostate cancer: a case report","route":"/key-papers/paper-powderly-fenbendazole-ivermectin-liver-injury-2026/"},{"id":"paper-thakurdesai-fenbendazole-liver-injury-2024","kind":"paper","name":"Severe drug-induced liver injury due to self-administration of the veterinary anthelmintic medication fenbendazole","route":"/key-papers/paper-thakurdesai-fenbendazole-liver-injury-2024/"}],"cancer":[{"id":"her2-mutant-nsclc","kind":"cancer","name":"HER2-mutant non-small-cell lung cancer","route":"/cancers/her2-mutant-nsclc/"},{"id":"kras-g12c-nsclc","kind":"cancer","name":"KRAS G12C-mutant non-small-cell lung cancer","route":"/cancers/kras-g12c-nsclc/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"}],"trial":[{"id":"beamion-lung-1","kind":"trial","name":"Beamion LUNG-1","route":"/trials/beamion-lung-1/"}]}}