Nonhepatic Cancer in Patients With Liver Cirrhosis: Epidemiology, Treatment Challenges, and Management Strategies.

Although the relationship between cirrhosis and hepatocellular carcinoma is well established, a growing body of evidence suggests patients with cirrhosis also face elevated risks of nonhepatic cancers (NHCs). Liver cirrhosis has been found to confer up to a two-fold increased risk for NHCs compared with the general population. Clinicians have limited guidance when treating patients with both NHCs and liver cirrhosis given there is a glaring paucity of data regarding optimal management strategies for this subset of patients. Hepatic dysfunction limits therapeutic and interventional approaches, alters the pharmacokinetics of common anticancer drugs, and increases the risk of side effects associated with anticancer treatment. Patients with well-compensated cirrhosis whose life expectancy is primarily determined by their NHC can be appropriate candidates for anticancer therapy with careful monitoring. Conversely, patients with decompensated cirrhosis should have their clinical focus shift toward managing liver-related complications or transitioning to palliative care because oncological treatment likely worsens overall prognosis. Prognostic models like Child-Pugh and Model for End-Stage Liver Disease scores can be used in a complementary fashion to identify appropriate patients and individualize treatment decisions. In this narrative review, we will examine the epidemiology of NHCs in patients with cirrhosis, the influence of hepatic dysfunction on therapeutic approaches, and the current strength of evidence on the safety and efficacy of common anticancer modalities in the setting of both compensated and decompensated cirrhosis.