Hepatotoxicity of chemotherapeutic and oncologic agents

Problems arise in cancer chemotherapy when liver function tests are not normal, when drugs that possess known hepatic toxicity are to be given, and when abnormalities arise after drug administration. Most hepatotoxic drug reactions are idiosyncratic, occuring because of either hypersensitivity mechanisms or host metabolic idiosyncrasy. The clinician must always consider that liver injury is due to an idiosyncratic drug reaction, especially in a setting where patients typically receive many drugs, such as an oncology service. Chemotherapeutic agents often possess predictable, dose-dependent ("direct") hepatotoxicity, however. This article addresses the spectrum of hepatotoxic effects of chemotherapeutic agents. The hepatotoxic potential of single-agent as well as combination chemotherapy is discussed and recommendations for dose modifications in patients with impaired hepatic function are provided.