A milk thistle compound with a long safety record. The better-evidenced half is supportive: whole milk thistle extract reduces chemotherapy-related liver enzyme rises and the painful hand and foot reaction. Tumour-shrinking claims rest on uncontrolled work by groups tied to the manufacturer. Harms are modest; the serious concerns are interactions. Controlled trials now running will settle the question. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Total bilirubin | Below 1.0 mg/dL (17 µmol/L) | Detects silibinin's most characteristic effect |
| Alanine aminotransferase (ALT) | Below 25 U/L in men, below 20 U/L in women | Most liver-specific marker of hepatocellular injury |
| Aspartate aminotransferase (AST) | Below 25 U/L | Separates liver injury from muscle or cardiac sources |
| Alkaline phosphatase | 60–90 U/L | Flags biliary obstruction, silibinin's excretion route |
| Estimated glomerular filtration rate (eGFR) | Above 90 mL/min/1.73 m² | Baseline before nephrotoxic chemotherapy |
| Fasting glucose | 75–85 mg/dL (4.2–4.7 mmol/L) | Detects additive glucose lowering |
| HbA1c | 4.8–5.4% | Confirms a sustained glucose shift |
| International normalised ratio (INR) | 0.9–1.1 if not anticoagulated; within the prescribed target if anticoagulated | Catches the documented warfarin interaction |
| Absolute neutrophil count | Above 2.0 × 10⁹/L | Detects the predicted irinotecan interaction |
| Phosphorylated STAT3 in tumour tissue | No established numeric target; scored positive or negative by immunohistochemistry, with positivity required for entry to current trials | Identifies who the STAT3 mechanism can plausibly help |
| Disease-specific tumour marker (for example PSA) | No established target on silibinin; track the slope against the individual's own pre-treatment baseline | Distinguishes disease change from marker noise |
Cadence: Liver panel at four weeks, then every eight to twelve weeks; INR weekly for four weeks after any start or stop, then monthly; fasting glucose twice weekly for the first month in treated diabetes; contrast brain imaging every eight weeks where brain metastases are the target.