Hepatotoxicity (liver enzyme elevation)
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.
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.
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