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Liver injury is a serious adverse effect linked to the administration of CPA. Nonetheless, the mechanism behind this toxicity remains incompletely elucidated; mechanistic investigations have identified oxidative stress, inflammatory responses, and apoptosis as pivotal elements contributing to CPA-induced liver dysfunction. In addition, CPA triggers the production of reactive oxygen species that act as damage-associated molecular patterns that rapidly activate TLR4\/MYD88\/NF-\u03baB and NLRP3 inflammasome signaling cascades. Additionally, Nrf2\/HO-1, \u03b1-klotho, and P-AMPK, which have anti-inflammatory and antioxidative characteristics, are thought to be important signaling pathways that mitigate oxidative stress in CPA-induced liver dysfunction. This review comprehensively covers all aspects of liver injury, including its epidemiology of drug-induced liver injury, risk factors, clinical presentation, chemotherapy-induced liver injury severity index, pathogenesis of CPA-induced liver injury and molecular mechanisms, and therapeutic choices. This study seeks to consolidate all known data about CPA-evoked liver injury, focusing on the probable redox molecular pathways underlying CPA-induced liver injury and recent drugs that showed a protective impact. In conclusion, studying these molecular pathways might open the way for early alleviation of hepatic dysfunction.<\/jats:p>","DOI":"10.1007\/s00210-025-04583-0","type":"journal-article","created":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T20:35:32Z","timestamp":1759005332000},"page":"2097-2112","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Unraveling chemotherapy-evoked hepatic dysfunction: a deep dive into cyclophosphamide-related liver injury"],"prefix":"10.1007","volume":"399","author":[{"given":"Ehab E.","family":"Sharata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina Ezzat","family":"Attya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa M.","family":"Khalaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remon Roshdy","family":"Rofaeil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramadan A. 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