“Decompensated liver disease” is a clinically heterogeneous group of patients. Patients with Child-Pugh score (CPS) class C liver disease will succumb to complications of their liver disease in a relatively short period of time and should receive only supportive care. CPS class B patients with good performance status may be considered for treatment, recognizing that this is based on safety data and a lack of high-level evidence that we can improve their survival with cancer treatment.