Chemotherapeutic agents can affect the glomerulus, renal tubules, interstitium or microvasculature. In renal impairment, drug excretion pathways by glomerular filtration and tubular secretion are inhibited, leading to increased systemic toxicity. Dose reductions were required in many drugs based on an estimation of glomerular filtration rate (GFR) and clinical signs of drug toxicity. Also, cytotoxic chemotherapy affected liver function by direct chemical reaction such as intrinsic hepatotoxicity or idiosyncratic reactions or immune mediated hypersensitivity. Therefore, liver function should be carefully assessed both prior to treatment and during therapy because an alteration of metabolism and excretion of chemotherapeutic drugs can lead to higher or more persistent drug levels, resulting in increased systemic toxicity (particularly myelosuppression) or worsening of chemotherapyinduced hepatotoxicity.