{"entity":{"id":"gallbladder-cancer-roadmap","kind":"roadmap","name":"Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials","aka":["Gallbladder carcinoma roadmap","Biliary tract cancer roadmap (gallbladder)"],"tldr":"Gallbladder cancer is usually found by accident when a gallbladder is removed for stones, and for most of its history the only treatment was a bigger operation. This roadmap follows the disease from the first cholecystectomy in 1882, through staging by depth and the borrowed chemotherapy standards of 2010 and 2019, to immunotherapy and HER2 drugs, and lists the trial readouts to watch to 2030.","summary":"Gallbladder cancer is the most common biliary tract cancer worldwide but rare in the countries that fund most trials, so its evidence has been borrowed: gemcitabine-cisplatin from ABC-02 (2010), adjuvant capecitabine from BILCAP (2019), durvalumab and pembrolizumab from TOPAZ-1 and KEYNOTE-966 (2022 to 2023) all came from mixed biliary populations in which gallbladder cancer was a subgroup. Its own evidence is surgical and observational: Nevin's staging by depth of invasion (1976), the residual disease series that justify re-resection of incidental cancer (Pawlik 2007), the timing window (Ethun 2017) and the T2a/T2b split that entered AJCC staging in 2017 (Shindoh 2015).\n\nTwo things are changing. HER2 is the first target where gallbladder cancer leads: about one in ten to one in five tumours are HER2-positive, HERIZON-BTC-01 produced a 41 percent response rate and zanidatamab was approved in 2024 (US), 2025 (EU, conditional) and 2026 (UK: MHRA in February, NICE TA1153 in May), with HERIZON-BTC-302 testing it first line. And the disease now has randomised trials of its own: OPT-IN and GAIN for chemotherapy before re-resection of incidental cancer, POLCAGB for radiotherapy before surgery in locally advanced disease, and adjuvant trials (ACTICCA-1, ARTEMIDE-Biliary01) large enough to report gallbladder subgroups.\n\nPrevention is the other half of the story. Chile's 2006 national prophylactic cholecystectomy programme, India's regional burden and the fourfold risk from chronic typhoid carriage are the levers in high-incidence regions, and the 2022 European polyp guideline is the closest thing to screening elsewhere; the Kaiser Permanente cohort suggests polyp surveillance finds little. The UK sits in the low-incidence world, with the CAPBIL study (2026) as its first national picture of practice; the NHS-specific gaps are named on the UK and NHS page for gallbladder cancer.","asOf":"2026-09-24","links":[{"label":"Hardy: Carl Langenbuch and the Lazarus Hospital, the first cholecystectomy in July 1882 (Aust N Z J Surg 1993)","url":"https://europepmc.org/article/MED/8466463"},{"label":"Traverso: Carl Langenbuch and the first cholecystectomy (Am J Surg 1976)","url":"https://europepmc.org/article/MED/782269"},{"label":"Glenn and Hays: the scope of radical surgery in malignant tumours of the extrahepatic biliary tract (Surg Gynecol Obstet 1954)","url":"https://europepmc.org/article/MED/13205425"},{"label":"Nevin et al.: carcinoma of the gallbladder, staging, treatment and prognosis (Cancer 1976)","url":"https://europepmc.org/article/MED/1247951"},{"label":"Piehler and Crichlow: primary carcinoma of the gallbladder, 6,222 reported patients (Surg Gynecol Obstet 1978)","url":"https://europepmc.org/article/MED/362580"},{"label":"Pawlik et al.: residual disease at re-resection for incidental gallbladder carcinoma (J Gastrointest Surg 2007)","url":"https://europepmc.org/article/MED/17846848"},{"label":"ABC-02: cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer (NEJM 2010)","url":"https://europepmc.org/article/MED/20375404"},{"label":"Shindoh et al.: tumour location predicts survival in T2 gallbladder cancer (Ann Surg 2015)","url":"https://europepmc.org/article/MED/24854451"},{"label":"Chun, Pawlik, Vauthey: AJCC 8th edition, pancreas and hepatobiliary cancers (Ann Surg Oncol 2018)","url":"https://europepmc.org/article/MED/28752469"},{"label":"Soreide et al.: systematic review of incidental gallbladder cancer management (Br J Surg 2019)","url":"https://europepmc.org/article/MED/30582640"},{"label":"ABC-06: second-line FOLFOX versus active symptom control (Lancet Oncol 2021)","url":"https://europepmc.org/article/MED/33798493"},{"label":"HERIZON-BTC-01: zanidatamab in HER2-amplified biliary tract cancer (Lancet Oncol 2023)","url":"https://europepmc.org/article/MED/37276871"},{"label":"TOPAZ-1 three-year overall survival update (J Hepatol 2025)","url":"https://europepmc.org/article/MED/40381735"},{"label":"ESMO Clinical Practice Guideline: biliary tract cancer (Ann Oncol 2023)","url":"https://europepmc.org/article/MED/36372281"},{"label":"Joint European guideline on gallbladder polyps (Eur Radiol 2022)","url":"https://europepmc.org/article/MED/34918177"},{"label":"Samaniego et al.: is it time to modify Chile's GES preventive cholecystectomy programme (Rev Med Chile 2024)","url":"https://europepmc.org/article/MED/40052976"},{"label":"CAPBIL: management of incidental gallbladder cancer in the UK (Br J Surg 2026)","url":"https://europepmc.org/article/MED/42013358"},{"label":"ClinicalTrials.gov NCT02170090","url":"https://clinicaltrials.gov/study/NCT02170090"},{"label":"ClinicalTrials.gov NCT04559139","url":"https://clinicaltrials.gov/study/NCT04559139"},{"label":"ClinicalTrials.gov NCT03673072","url":"https://clinicaltrials.gov/study/NCT03673072"},{"label":"ClinicalTrials.gov NCT02867865","url":"https://clinicaltrials.gov/study/NCT02867865"},{"label":"ClinicalTrials.gov NCT06109779","url":"https://clinicaltrials.gov/study/NCT06109779"},{"label":"ClinicalTrials.gov NCT06282575","url":"https://clinicaltrials.gov/study/NCT06282575"},{"label":"ClinicalTrials.gov NCT03875235","url":"https://clinicaltrials.gov/study/NCT03875235"},{"label":"ClinicalTrials.gov NCT04482309","url":"https://clinicaltrials.gov/study/NCT04482309"}],"tags":["gallbladder","biliary","roadmap"],"related":["immunotherapy-roadmap","chemotherapy-roadmap","surgery-roadmap","prevention-roadmap","early-detection-roadmap","ctdna-tests","gemcis-plus-io-btc","idea-gbc-report-gallbladder-separately-in-biliary-trials","idea-gbc-national-incidental-cancer-pathway","idea-gbc-t1b-simple-cholecystectomy-prospective-study","idea-gbc-t2a-spare-liver-resection-trial","idea-gbc-reflex-her2-testing-advanced-biliary","idea-gbc-risk-targeted-ultrasound-in-high-incidence-regions","idea-gbc-prophylactic-cholecystectomy-targeted-and-evaluated","idea-gbc-typhoid-carrier-cholecystectomy-or-surveillance","idea-gbc-ctdna-residual-disease-guided-adjuvant-trial","idea-gbc-neoadjuvant-for-high-risk-incidental-cancer","idea-gbc-randomised-adjuvant-chemoradiation-r1-node-positive","idea-gbc-burden-to-funding-audit-and-dedicated-call"],"cancers":["gallbladder","biliary-tract-cancer","cholangiocarcinoma","extrahepatic-cholangiocarcinoma"],"sections":["surgery","chemotherapy","immunotherapy","targeted-therapy","prevention","early-detection"],"technologies":["checkpoint-inhibitor","bispecific-antibody","cytotoxic-chemotherapy","liquid-biopsy","mrd-testing","ultrasound"],"targets":["her2"],"drugs":["gemcitabine-cisplatin","capecitabine","durvalumab","pembrolizumab","folfox","zanidatamab","trastuzumab-deruxtecan","rilvegostomig","signatera"],"companies":["astrazeneca","merck","jazz","zymeworks"],"institutions":["cruk","the-christie","tata-memorial","ecog-acrin","swog","esmo","nci"],"pathways":[],"terms":["incidental-gallbladder-cancer","radical-cholecystectomy","t2a-versus-t2b","gallbladder-polyp","prophylactic-cholecystectomy","tnm-staging","neoadjuvant-adjuvant","chemoradiation","ctdna","mrd","her2-positive"],"trials":["abc-02","bilcap","abc-06","topaz-1","keynote-966","herizon-btc-01","herizon-btc-302","destiny-pantumor02","nifty","naliricc","swog-s0809","opt-in","gain-igbc","polcagb","acticca-1","nct06109779"],"people":["juan-valle","john-primrose","angela-lamarca"],"bottlenecks":["b-rare-cancers","b-early-detection","b-prevention-adoption","b-trial-enrolment","b-biomarker-validation","b-dormancy-mrd","b-care-fragmentation","b-funding-allocation"],"keyPapers":["paper-abc-02-gemcitabine-cisplatin-nejm-2010","paper-bilcap-lancet-oncol-2019","paper-topaz-1-nejm-evidence-2022","paper-keynote-966-lancet-2023","paper-harding-lancet-oncol","paper-destiny-pantumor02-jco-2024","paper-abc-06-folfox-second-line-lancet-oncol-2021","paper-esmo-biliary-tract-cancer-guideline-ann-oncol-2023","paper-shindoh-t2-gallbladder-cancer-tumour-location-ann-surg-2015","paper-pawlik-incidental-gallbladder-cancer-residual-disease-jgs-2007","paper-roa-gallbladder-cancer-primer-nat-rev-dis-primers-2022","paper-mcclements-capbil-incidental-gallbladder-cancer-bjs-2026","paper-who-2019-digestive-system-tumours-nagtegaal-histopathology-2020"],"journals":[],"dependsOn":[],"notes":["How this stays current: scripts/roadmap-watch.ts (npm run roadmap:watch) checks each trial here against ClinicalTrials.gov and searches Europe PMC for new papers on the acronyms since asOf. Anything it prints that this page does not say is an edit to make; then move asOf forward.","Dates in 'What to watch' are quoted from the registry as read on 2026-09-24 and are not predictions; estimated completion dates move.","UK and NHS specifics (referral routes, NICE positions, Cancer Drugs Fund status, cholecystectomy histology policy) are held on the UK and NHS page for gallbladder cancer and are not restated here."],"steps":[{"era":"1882-1954","title":"Surgery arrives, and the cancer is found by accident","description":"Carl Langenbuch performed the first cholecystectomy at the Lazarus Hospital in Berlin in July 1882, an operation for gallstones that would become one of the commonest in the world and the way most gallbladder cancers come to light. In 1954 Glenn and Hays set out the scope of radical surgery for cancers of the extrahepatic biliary tract, the origin of the radical cholecystectomy: gallbladder, liver bed and regional lymph nodes removed together. For the next half century that operation was the whole of treatment.","refs":["radical-cholecystectomy","incidental-gallbladder-cancer","surgery","gallbladder"],"status":"historic"},{"era":"1976-2017","title":"Staging by depth, then by side","description":"Nevin and colleagues staged 66 cases by depth of invasion in 1976 and noted that essentially all had been found incidentally at gallstone surgery; Piehler and Crichlow's 1978 review of 6,222 reported patients described an elderly, mostly female population presenting either as stone disease or as incurable cancer. Depth of invasion became the T category of TNM. In 2015 Shindoh and colleagues showed in 437 patients that T2 tumours on the hepatic side did far worse than those on the peritoneal side (five-year survival 42.6 versus 64.7 percent), and the AJCC eighth edition of 2017 split T2 into T2a and T2b, the one staging change that came from gallbladder cancer's own anatomy.","refs":["paper-nevin-gallbladder-carcinoma-staging-cancer-1976","paper-shindoh-t2-gallbladder-cancer-tumour-location-ann-surg-2015","paper-chun-ajcc-8th-edition-hepatobiliary-aso-2018","paper-giannis-ajcc8-gallbladder-staging-validation-cancers-2021","t2a-versus-t2b","tnm-staging"],"status":"historic"},{"era":"2007-2026","title":"The incidental cancer pathway: re-resect from T1b, but who, when and how much","description":"Pawlik and colleagues found residual disease in 46 percent of 115 re-resection specimens in 2007, and the rule that T1b or deeper incidental cancers go back to theatre followed. Ethun's ten-centre analysis (2017) put the best interval at four to eight weeks; a 2026 individual patient data meta-analysis found timing made no measurable difference. The Dutch registry showed only 24 percent of eligible patients were re-resected (2020); the UK CAPBIL study (2026) found 67.7 percent had liver resection across 24 centres. Whether T1b tumours need the second operation at all (Kim 2018: five-year disease-specific survival 93.7 versus 95.5 percent) and whether peritoneal-side T2a tumours need the liver resected are the surgical questions still open.","refs":["paper-pawlik-incidental-gallbladder-cancer-residual-disease-jgs-2007","paper-ethun-re-resection-timing-incidental-gallbladder-cancer-jama-surg-2017","paper-selvakumar-revision-surgery-timing-ipd-meta-analysis-hpb-2026","paper-de-savornin-lohman-re-resection-incidental-gallbladder-cancer-aso-2020","paper-mcclements-capbil-incidental-gallbladder-cancer-bjs-2026","paper-kim-t1b-gallbladder-cancer-international-jhbps-2018","paper-kang-t2-gallbladder-cancer-location-meta-analysis-jcm-2021","paper-soreide-incidental-gallbladder-cancer-review-bjs-2019","incidental-gallbladder-cancer","radical-cholecystectomy","idea-gbc-national-incidental-cancer-pathway","idea-gbc-t1b-simple-cholecystectomy-prospective-study","idea-gbc-t2a-spare-liver-resection-trial"],"status":"current"},{"era":"2010","title":"A borrowed chemotherapy standard","description":"ABC-02, a Cancer Research UK trial of 410 patients with advanced biliary tract cancer including gallbladder cancer, showed in 2010 that gemcitabine plus cisplatin lengthened survival from 8.1 to 11.7 months (hazard ratio 0.64). It gave gallbladder cancer its first drug standard and the control arm for every first-line trial since, but the gallbladder subgroup has never had a trial of its own in this setting.","refs":["abc-02","paper-abc-02-gemcitabine-cisplatin-nejm-2010","gemcitabine-cisplatin","cruk","juan-valle","chemotherapy"],"status":"historic"},{"era":"2017-2021","title":"Adjuvant capecitabine and second-line FOLFOX, from UK trials","description":"BILCAP (reported 2017, published 2019) randomised 447 resected biliary cancers to six months of capecitabine or observation; the intention-to-treat result missed significance (hazard ratio 0.81, p=0.097) yet capecitabine became the adjuvant standard in the UK, Europe and the United States. ABC-06 (2019, published 2021) showed second-line FOLFOX added about a month of median survival and doubled one-year survival (25.9 versus 11.4 percent). NIFTY (2021) added liposomal irinotecan as a Korean option that the German NALIRICC trial later failed to reproduce. The UK CAPBIL surgical cohort (2026) saw no adjuvant benefit in matched analysis, so ACTICCA-1's readout matters.","refs":["bilcap","paper-bilcap-lancet-oncol-2019","abc-06","paper-abc-06-folfox-second-line-lancet-oncol-2021","nifty","paper-nifty-liposomal-irinotecan-lancet-oncol-2021","naliricc","paper-mcclements-capbil-surgical-outcomes-gallbladder-cancer-hpb-2026","capecitabine","folfox","john-primrose","angela-lamarca","the-christie"],"status":"current"},{"era":"2008-2015","title":"Radiotherapy: one single-arm trial and a nomogram","description":"SWOG S0809 (accrued 2008 to 2014, published 2015) gave 79 patients with resected gallbladder or extrahepatic bile duct cancer gemcitabine-capecitabine then chemoradiation: two-year survival was 65 percent and, unusually, no worse after a positive margin (60 percent) than a clear one (67 percent). With Wang's 2011 SEER-Medicare nomogram it is the basis of the US option of chemoradiation after node-positive or margin-positive resection. No randomised trial followed and UK practice rarely uses it; POLCAGB in Mumbai is testing radiotherapy before surgery in locally advanced disease instead.","refs":["swog-s0809","paper-swog-s0809-adjuvant-chemoradiation-jco-2015","paper-wang-adjuvant-chemoradiotherapy-nomogram-gallbladder-cancer-jco-2011","polcagb","chemoradiation","radiotherapy","swog","idea-gbc-randomised-adjuvant-chemoradiation-r1-node-positive"],"status":"historic"},{"era":"2022-2025","title":"Immunotherapy joins chemotherapy","description":"TOPAZ-1 (2022) added durvalumab to gemcitabine-cisplatin and KEYNOTE-966 (2023) added pembrolizumab; both trials were positive with small median gains and a growing tail of long survivors. The TOPAZ-1 three-year update (2025) reported 36-month survival of 14.6 versus 6.9 percent and extended long-term survivors in 17.0 versus 8.7 percent. Gallbladder cancer was a subgroup in both trials; US and Chilean immunogenomic profiling (2025) shows its immune environment differs by population even where mutations do not.","refs":["topaz-1","paper-topaz-1-nejm-evidence-2022","paper-topaz-1-three-year-survival-j-hepatol-2025","keynote-966","paper-keynote-966-lancet-2023","gemcis-plus-io-btc","durvalumab","pembrolizumab","paper-zhu-population-specific-immunogenomics-gallbladder-cancer-mod-pathol-2025","checkpoint-inhibitor","immunotherapy","idea-gbc-report-gallbladder-separately-in-biliary-trials"],"status":"current"},{"era":"2017-2025","title":"HER2: the first target where gallbladder cancer leads","description":"The 2017 Manchester meta-analysis put HER2 overexpression at about 20 percent in extrahepatic biliary cancers against 5 percent in intrahepatic tumours; a 2026 resected series using the trial definition found 9.4 percent of gallbladder cancers positive, often heterogeneous. HERIZON-BTC-01 (2023) gave zanidatamab to 80 HER2-positive patients after chemotherapy with a 41.3 percent confirmed response rate, and the FDA granted accelerated approval in November 2024, the European Commission conditional approval in June 2025, the MHRA approval in February 2026 and NICE a recommendation in May 2026 (TA1153); DESTINY-PanTumor02 gave trastuzumab deruxtecan a tumour-agnostic HER2 3+ route. HERIZON-BTC-302 is testing zanidatamab first line with an estimated primary completion of December 2028. Testing uptake, not drug supply, is now the limiting step.","refs":["paper-galdy-her2-biliary-tract-meta-analysis-cancer-metastasis-rev-2017","paper-angerilli-her2-gallbladder-extrahepatic-concordance-hum-pathol-2026","herizon-btc-01","paper-harding-lancet-oncol","herizon-btc-302","destiny-pantumor02","paper-destiny-pantumor02-jco-2024","zanidatamab","trastuzumab-deruxtecan","her2","her2-positive","jazz","idea-gbc-reflex-her2-testing-advanced-biliary"],"status":"current"},{"era":"2006-2026","title":"Prevention where the burden is: Chile, India and typhoid","description":"Chile's Explicit Health Guarantees programme has guaranteed cholecystectomy for gallstones at ages 35 to 49 since 2006, issuing 284,139 notifications by 2024; mortality has fallen, but it was falling before the programme and uptake does not follow incidence. India carries about a tenth of world cases, concentrated in the Gangetic belt, and Tata Memorial's registry saw 60 percent of 1,950 patients arrive with metastases. Chronic Salmonella Typhi carriage carries a roughly fourfold risk in two meta-analyses. Elsewhere the 2022 European polyp guideline is the only screening-like pathway, and the Kaiser Permanente cohort (2020) found people with polyps no more likely to develop the cancer than people without.","refs":["prophylactic-cholecystectomy","paper-samaniego-chile-ges-programme-evaluation-rev-med-chile-2024","paper-mardones-frenz-chile-ges-mortality-rev-med-chile-2019","paper-cid-chile-programme-gallbladder-cancer-mortality-am-j-epidemiol-2024","paper-dutta-gallbladder-cancer-epidemiology-india-chin-clin-oncol-2019","paper-patkar-tata-memorial-gallbladder-cancer-registry-cancer-epidemiol-2025","paper-koshiol-salmonella-typhi-gallbladder-cancer-cancer-med-2016","paper-nagaraja-eslick-typhi-carrier-gallbladder-cancer-meta-analysis-apt-2014","paper-gallbladder-polyp-joint-guideline-eur-radiol-2022","paper-szpakowski-gallbladder-polyps-20-year-cohort-jama-netw-open-2020","gallbladder-polyp","tata-memorial","prevention","idea-gbc-risk-targeted-ultrasound-in-high-incidence-regions","idea-gbc-prophylactic-cholecystectomy-targeted-and-evaluated","idea-gbc-typhoid-carrier-cholecystectomy-or-surveillance"],"status":"current"},{"era":"2026-2030","title":"What the registry says is coming","description":"For the first time gallbladder cancer has randomised trials that ask its own questions. OPT-IN (ECOG-ACRIN, phase 2/3, estimated primary completion July 2028) tests chemotherapy before re-resection of incidental cancer; GAIN closed in October 2024 with 68 of 333 planned patients and awaits publication; POLCAGB (Tata Memorial) compares chemoradiation with chemotherapy before surgery in locally advanced disease. ACTICCA-1 (789 patients, estimated primary completion December 2025) and ARTEMIDE-Biliary01 (760, January 2029) will say whether gemcitabine-cisplatin or added immunotherapy beats capecitabine after surgery, and HERIZON-BTC-302 whether HER2-positive patients should get zanidatamab from the start. Residual disease blood tests are prognostic after biliary resection (hazard ratios of 16 and 26 in two 2025 to 2026 cohorts) but no trial yet acts on them.","refs":["opt-in","gain-igbc","polcagb","acticca-1","nct06109779","herizon-btc-302","paper-malla-ctdna-resected-biliary-tract-cancer-esmo-gi-onc-2026","paper-yu-ctdna-early-recurrence-biliary-tract-cancer-jco-po-2025","mrd-testing","liquid-biopsy","idea-gbc-ctdna-residual-disease-guided-adjuvant-trial","idea-gbc-neoadjuvant-for-high-risk-incidental-cancer"],"status":"emerging"},{"era":"What sets the pace","title":"Under-studied relative to burden","description":"Gallbladder cancer has been called a rare tumour about which knowledge is scant (2004) and an understudied disease (2025) by successive generations of researchers. The reasons are structural: it is rare where trials are funded and common where they are not; most cases are found incidentally and treated by surgeons rather than oncologists; and it is pooled with bile duct cancer in every drug trial, so its results are subgroups. Whole-exome work across five countries (2026) shows the biology itself differs by population. Separate reporting, a burden-to-funding audit and national incidental cancer pathways are the levers this page proposes; the UK-specific gaps are set out on the UK and NHS page for gallbladder cancer.","refs":["paper-wistuba-gazdar-gallbladder-cancer-lessons-nat-rev-cancer-2004","paper-roa-gallbladder-cancer-primer-nat-rev-dis-primers-2022","paper-garate-calderon-gallbladder-cancer-worldwide-exome-ebiomedicine-2026","b-rare-cancers","b-funding-allocation","b-trial-enrolment","idea-gbc-burden-to-funding-audit-and-dedicated-call","idea-gbc-report-gallbladder-separately-in-biliary-trials","idea-gbc-national-incidental-cancer-pathway"],"status":"current"}],"watch":[{"item":"ACTICCA-1 primary completion: adjuvant gemcitabine-cisplatin vs capecitabine after resection of cholangiocarcinoma and muscle-invasive gallbladder cancer (789 patients; status active, not recruiting)","expected":"2025-12","source":"https://clinicaltrials.gov/study/NCT02170090","refs":["acticca-1","bilcap","capecitabine","gemcitabine-cisplatin"]},{"item":"GAIN: primary publication of the closed German trial of neoadjuvant gemcitabine-cisplatin before re-resection of incidental gallbladder cancer (completed 10 October 2024 with 68 participants)","expected":"2024-10-10","source":"https://clinicaltrials.gov/study/NCT03673072","refs":["gain-igbc","incidental-gallbladder-cancer"]},{"item":"POLCAGB primary completion: neoadjuvant chemoradiation vs chemotherapy in locally advanced gallbladder cancer (124 participants; study completion listed as 10 September 2027)","expected":"2025-09-10","source":"https://clinicaltrials.gov/study/NCT02867865","refs":["polcagb","chemoradiation"]},{"item":"TOPAZ-1 study completion on the registry (durvalumab plus gemcitabine-cisplatin, first line)","expected":"2027-05-16","source":"https://clinicaltrials.gov/study/NCT03875235","refs":["topaz-1","durvalumab"]},{"item":"DESTINY-PanTumor02 study completion (trastuzumab deruxtecan in HER2-expressing tumours including biliary)","expected":"2027-03-23","source":"https://clinicaltrials.gov/study/NCT04482309","refs":["destiny-pantumor02","trastuzumab-deruxtecan"]},{"item":"OPT-IN (EA2197) primary completion: perioperative vs adjuvant chemotherapy for incidental gallbladder cancer (186 estimated participants)","expected":"2028-07-01","source":"https://clinicaltrials.gov/study/NCT04559139","refs":["opt-in","incidental-gallbladder-cancer"]},{"item":"HERIZON-BTC-302 primary completion: first-line zanidatamab with standard of care in HER2-positive biliary tract cancer (286 estimated participants)","expected":"2028-12-01","source":"https://clinicaltrials.gov/study/NCT06282575","refs":["herizon-btc-302","zanidatamab","her2"]},{"item":"ARTEMIDE-Biliary01 primary completion: adjuvant rilvegostomig plus chemotherapy after resection of biliary tract cancer (760 participants)","expected":"2029-01-02","source":"https://clinicaltrials.gov/study/NCT06109779","refs":["nct06109779","rilvegostomig"]},{"item":"Chile: a redesign or formal evaluation of the GES preventive cholecystectomy programme, as its 2024 evaluation recommends; no date in the sources read","source":"https://europepmc.org/article/MED/40052976","refs":["prophylactic-cholecystectomy"]},{"item":"A trial that acts on a positive residual disease blood test after biliary resection; none found on ClinicalTrials.gov or Europe PMC on 24 September 2026","source":"https://europepmc.org/article/MED/42583118","refs":["mrd-testing","idea-gbc-ctdna-residual-disease-guided-adjuvant-trial"]}]},"route":"/roadmaps/gallbladder-cancer-roadmap/","neighbours":{"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in 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