“…Shah et al indeed reported that 25−35% of clinical trial patients treated with TKI showed a low-grade elevation in alanine and/or aspartate aminotransferases, and approximately 2% of them developed high-grade increases in serum transaminases, with a wide variability among TKI. 8 Although little is known about the underlying mechanisms, it is thought that liver toxicity could be due to reactive metabolites (RM) and as well as being immune-related. RM reactivity is associated with the presence of electrophilic moieties or radicals originating from the metabolic transformation, often called bioactivation, of particular functional groups known as structural alerts or toxicophores.…”