Liver Injury

irritation or injury of the liver also called hepatotoxicity

Diagram of a woman with highlighted liver and digestive organs, displaying bloodwork results, symptoms of severe liver injury such as jaundice, dark urine, stomach pain, appetite loss, nausea, and vomiting.

When does liver injury start and how long does it last?

A timeline showing the progression of liver injury, beginning within the first 2-3 months of treatment, with labeled months and weeks.

How serious is liver injury?

Severity most often experienced is grade 1 or 2

How likely is it that I will experience liver injury?

Diagram showing three bottles of medication labeled Lorlatinib, Alectinib, and Crizotinib. The Lorllatinib bottle is solid blue with 'NA' on it, indicating liver injury is uncommon. The Alectinib and Crizotinib bottles contain pills, with text indicating 38% and 36% of people will experience liver injury, respectively.

Prevention Strategies

blood vial with magnifying glass

  • Tell your healthcare team if you have a history of liver problems.

    Liver function tests are monitored through bloodwork. These tests should be taken at the start of treatment and  every 2 weeks during the first 2-3 months of treatment.

    Why: this helps catch changes in liver function early and treat them before they become a problem.

liver with plus sign

  • Don’t smoke or drink alcohol.

    Eat healthy fats, fruits, vegetables, and whole grains.

    Why: Alcohol and the chemicals found in cigarettes (such as nicotine and tar) are toxic to the liver. ALKi themselves can cause liver damage so the liver is already under stress.

pill bottles labeled rifampin and St. Johns Wort

  • Talk to your healthcare team about medications, supplements, and herbal products that you use:

    • Rifampin is an antibiotic mainly used to treat tuberculosis or meningitis.

    • St. John's wort is a herbal product that can be found in oral supplements, teas, or creams, and is used to treat depression and symptoms of menopause.

    Why: these products affect ALKi medications and can increase the risk of liver injury.

Management Strategies

doctor holding plus sign

  • Based on the severity of liver injury your healthcare practitioner will make adjustments to your medication.

    Mild to moderate impairments require no adjustment. Your healthcare team will continue monitoring bloodwork.

doctor holding pause sign

  • Based on the severity of liver toxicity your healthcare team will make adjustments to your medication.

    Significant impairments require a temporary pause of medication until liver function returns to normal.

    If liver function does not improve, your healthcare team might reduce the dose of ALKi.

doctor holding stop sign

  • Based on the severity of liver injury your healthcare team will make adjustments to your medication.

    Severe impairments require greater dose reductions or to permanently discontinue ALKi treatment.

    Your healthcare team will likely recommend another type of ALKi or alternative treatment.

Emergent Symptoms

If you are unsure, it is always safer to seek medical care.
Tell emergency staff you are on an ALK inhibitor for lung cancer.

phone

Call a Healthcare Provider

Call your care team

  • Not feeling hungry

  • Feeling sick to your stomach

  • Throwing up

  • Mild belly pain

  • Feeling more tired than usual

  • Itching with no rash

  • Light-colored poop

ambulance

Visit an Emergency Room

Call 911 or drive to your closest emergency room

  • Yellow skin or yellow eyes

  • Dark brown urine

  • Strong pain on the right side of your belly

  • New confusion or very hard to stay awake

  • Throwing up that will not stop

  • Easy bruising or bleeding

  • Severe weakness or you collapse

Download Liver Injury Info Sheet
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