Liver function tests in cancer and chemotherapy
How to read abnormal LFTs in a patient with cancer, with worked results; metastases versus obstruction versus drug injury, CTCAE v6.0 grading (which changed for abnormal baselines), hepatic dose modification, checkpoint inhibitor hepatitis and hepatitis B reactivation.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Abnormal LFTs in cancer have five main causes: metastases or infiltration, biliary obstruction, drug injury, infection (especially hepatitis B reactivation) and non-hepatic sources (bone, muscle, haemolysis).
- Read the pattern first, then magnitude, then synthetic function. The physiology of each marker and the R ratio are in Liver function tests: what each marker reflects; this note applies them to oncology.
- LFTs do three jobs here: they find disease, they set dose modifications before each cycle, and they grade toxicity (CTCAE), which decides whether to hold or stop a drug.
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Sources
- eviQ Cancer Treatments Online (hepatic dose modification in protocols, hepatitis B screening and prophylaxis, immunotherapy toxicity)AU/NZCancer Institute NSW
- Therapeutic Guidelines: Gastrointestinal (abnormal liver biochemistry, drug-induced liver injury)AU/NZTherapeutic Guidelines Limited
- Common Terminology Criteria for Adverse Events (CTCAE) version 6.0US National Cancer Institute, Cancer Therapy Evaluation Program, v6.0 (2025; used for new NCI trials from January 2026)
- Schneider BJ et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol 2021;39:4073-126American Society of Clinical Oncology, 2021 (latest full update found, November 2026)
- Haanen J et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline. Ann Oncol 2022;33:1217-38European Society for Medical Oncology, 2022
- Hwang JP et al. Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update. J Clin Oncol 2020;38:3698-715American Society of Clinical Oncology, 2020 (current, November 2026)
- Ali FS et al. AGA clinical practice guideline on the prevention and treatment of hepatitis B virus reactivation in at-risk individuals. Gastroenterology 2025;168:267-84American Gastroenterological Association, 2025
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy