Docetaxel has been associated with serum aminotransferase elevations in up to half of patients, but values greater than 5 times the upper limit of normal (ULN) occur in less than 2%. Similar rates of alkaline phosphatase elevations and occasional mild bilirubin elevations also occur. The abnormalities are usually asymptomatic, mild and self-limited, rarely requiring dose modification or discontinuation. Despite the frequency of serum enzyme elevations during therapy, clinically apparent liver injury from docetaxel is rare. Nevertheless, individual case reports of severe acute hepatic necrosis attributed to docetaxel have been published, usually arising within a few days or weeks after a severe hypersensitivity reaction to the first or second infusion of docetaxel (Case 1). The typical case arises within days of the infusion of docetaxel and is associated with rapid, marked rises in serum aminotransferase levels with subsequent appearance of jaundice. With severe injury there is early hepatic and multiorgan failure with jaundice and progressive hepatic encephalopathy, coagulopathy, and ascites. Immunoallergic features (fever, rash, flushing) are common initially, but may be obscured by corticosteroid therapy. Liver biopsy generally reveals zone 3 (centrolobular) necrosis and variable degrees of inflammation and cholestasis. Because docetaxel is often given with other antineoplastic agents, liver injury arising during therapy cannot always be attributed reliably to docetaxel as opposed to another specific agent. Furthermore, docetaxel in combination with other antineoplastic agents may be associated with reactivation of hepatitis B, increased risk of opportunistic viral infections, sinusoidal obstruction syndrome and sepsis, any of which can cause liver test abnormalities or clinically apparent liver injury.