Review for 10.1186/s12876-022-02121-3 (2022)

Reviewer’s report
Title: 
Severe tyrosine-kinase inhibitor induced liver injury in metastatic renal
cell carcinoma patients: Two case reports assessed for causality using the
updated RUCAM and review of the literature
Version: 
1 
Date: 
21 Oct 2021
Reviewer's report:
The authors describe two rare cases of liver toxicity in patients with metastatic
renal cell carcinoma after treatment with tyrosine kinase inhibitors pazopanib
and sunitinib.
The presentation of the cases is clear and the structure of the manuscript well
designed. The cases and the discussion presented here are especially interensting
from a toxicological point of view to oncological patients.
I suggest minor revisions to further improve the quality of the manuscript as
follows:
1. While the metobolism for sunitinib is discussed in detail, such information for
pazopanib remains rather superficial. More details on which metabolites are
produced in the liver and how they might contribute to hepatotoxicity would be
of interest.
2. The manuscript does not contain any tables or figures. As many readers prefer
a visual display of key elements of a manuscript, adding at least one figure
should be recommended. This could be a schematic display of the course of the
diseases of the patients as time lines or an overview of the hepatic metabolism of
the drugs described here (just to give ideas).
3. Only less than 35% (24 out of 72) of the references are younger than 5 years.
It is advised to check whether more current literature could be cited at some
instances.
4. Language: The manuscript contains some spelling and grammar mistakes -
please check carefully. Further, please check to write out all abbreviations when
first mentioned (as it is not the case for mRCC, first sentence in background
section).
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
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Yes
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Yes
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Yes
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from apparent manipulation?
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