Pharmacometabolomics has been already successfully used in toxicity prediction for one specific adverse effect.However in clinical practice,two or more different toxicities are always accompanied with each other,which puts forward new challenges for pharmacometabolomics.Gastrointestinal toxicity and myelosuppression are two major adverse effects induced by Irinotecan (CPT-11),and often show large individual differences.In the current study,a pharmacometabolomic study was performed to screen the exclusive biomarkers in predose serums which could predict late-onset diarrhea and myelosuppression of CPT-1 1 simultaneously.The severity and sensitivity differences in gastrointestinal toxicity and myelosuppression were judged by delayed-onset diarrhea symptoms,histopathology examination,relative cytokines and blood cell counts.Mass spectrometry-based non-targeted and targeted metabolomics were conducted in sequence to dissect metabolite signatures in predose serums.Eventually,two groups of metabolites were screened out as predictors for individual differences in late-onset diarrhea and myelosuppression using binary logistic regression,respectively.This result was compared with existing predictors and validated by another independent exteal validation set.Our study indicates the prediction of toxicity could be possible upon predose metabolic profile.Pharmacometabolomics can be a potentially useful tool for complicating toxicity prediction.Our findings also provide a new insight into CPT-11 precision medicine.