pairingsPairing
Gemcitabine-cisplatin + PD-(L)1 blockade in biliary cancer
Chemotherapy plus immunotherapy is now the first treatment for advanced bile duct cancer, with a small average gain and a minority of long survivors.
TOPAZ-1 (durvalumab, OS HR 0.76) and KEYNOTE-966 (pembrolizumab, OS HR 0.83) both positive; 2-year survival roughly doubled. No predictive biomarker (PD-L1, TMB, MSI) reliably identifies the long-term survivors.
Rationale
Chemotherapy-induced immunogenic cell death plus checkpoint blockade; biliary cancers have an inflamed stroma.
Evidence
Two phase 3 trials.