Biliary tract cancer (cholangiocarcinoma): lines of therapy Print / save PDF Cancer page → 12 standard-of-care settings across 5 lines and 4 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Line All comers FGFR HER2 IDH Screening, prevention and diagnosis 1 · · · Early / localised 2 · · · Advanced, first line 4 · · · Second line 1 1 1 1 Other settings 1 · · ·
Screening, prevention and diagnosis Subgroup Setting Approach Products and trials Guideline Evidence All comers Diagnosis and staging Contrast CT/MRI with MRCP; ERCP biopsy molecular profiling DNA RNA NGS NCCN · Molecular testing recommended (category 2A) 75
Early / localised Subgroup Setting Approach Products and trials Guideline Evidence All comers Resectable Surgery + adjuvant
NCCN Guidelines: Biliary Tract Cancers — All comers Resectable Margin-negative hepatectomy Whipple lymphadenectomy adjuvant BILCAP NCCN · Capecitabine category 2A (preferred) ESMO-MCBS · B 69
Advanced, first line Subgroup Setting Approach Products and trials Guideline Evidence All comers Advanced Gem-cis + PD-(L)1 targeted therapy NCCN Guidelines: Biliary Tract Cancers 98 All comers Unresectable perihilar in selected patients Neoadjuvant chemoradiation NCCN · Category 2B, transplant centres only 40 All comers Advanced, first line Gemcitabine-cisplatin + durvalumab TOPAZ-1 pembrolizumab KEYNOTE-966 zanidatamab HER2+ NCCN · Category 1 (preferred) ESMO-MCBS · TOPAZ-1 grade 3 98 All comers Advanced, other alterations Zenocutuzumab BRAF V600E pembrolizumab dostarlimab MSI-H larotrectinib NCCN · Category 2A (tumour-agnostic) 98
Second line Subgroup Setting Approach Products and trials Guideline Evidence All comers Second-line, no target FOLFOX irinotecan 5-FU NALIRICC clinical trials NCCN · FOLFOX category 1 93 FGFR Advanced, FGFR2 fusion after chemotherapy Pemigatinib futibatinib tinengotinib FIRST-308 after progression NCCN · Category 2A 67 HER2 Advanced, HER2-positive after chemotherapy Zanidatamab IHC 3+ amplified trastuzumab deruxtecan IHC NCCN · Category 2A 97 IDH Advanced, IDH1 mutation after chemotherapy Ivosidenib ClarIDHy NCCN · Category 1 89
Other settings Subgroup Setting Approach Products and trials Guideline Evidence All comers Locoregional (intrahepatic, liver-confined) Y-90 hepatic arterial infusion chemotherapy SBRT phase 3 NCCN · Category 2B 40
Sequence and caution pairings Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.