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Tyrosine kinase inhibitors (TKIs) are used for the targeted treatment of solid cancers. TKIs produce a variable incidence of liver adverse events (5-25%) which can progress to severe liver injury in a minority of patients if treatment is maintained despite ongoing injury. This risk requires careful patient management to maintain treatment benefit without harm. This review highlights the various mechanisms of idiosyncratic hepatotoxicity, the formation of reactive metabolites and how this leads to toxicity. These critical events depend of the drug-specific characteristics of each TKI and the patient risk factors, especially genetic characterization. With improved understanding of the mechanisms leading to hepatotoxicity, several strategies have been adopted to prevent or treat this side effect. Recommendations on liver function liver test monitoring have been proposed according to each TKI.

Malnutrition is a common problem in cancer patients, associated with an increased risk of complications and a reduced response to treatment resulting to a poorer outcome. Both age and oncological disease can affect the state of nutrition in multiple ways. In elderly, malnutrition can be affected either directly by the tumour process (local effect, host response to the tumour ...), by the adverse effects of the treatment, and by the impact of several psychosociological and physiological factors due to aging. Prophylactic interventions in all these stages should therefore be done, addressing the specific needs of this patients group, and suggesting the systematic use of an out-patient screening tool (MNA). Assessing and modifying nutrition must be an integral part of the treatment.