OnCo

Gallbladder cancer: lines of therapy

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4 standard-of-care settings across 3 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersHER2
Advanced, first line1·
Second line·1
Other settings2·

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersUnresectable or metastatic, first lineGemcitabine-cisplatin plus durvalumab (TOPAZ-1) or pembrolizumab (KEYNOTE-966), with molecular profiling at diagnosis.98

Second line

SubgroupSettingApproachProducts and trialsEvidence
HER2Second line and biomarker-directedFOLFOX (ABC-06); zanidatamab for HER2-positive disease after prior therapy (HERIZON-BTC-01); tumour-agnostic options for MSI-high (pembrolizumab), BRAF V600E (dabrafenib-trametinib) and NTRK fusions (larotrectinib, entrectinib).84

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersIncidental cancer at cholecystectomy, T1b or deeperRe-resection: liver bed (segments IVb/V) with portal lymphadenectomy, and bile duct excision if the cystic duct margin is positive; port sites are no longer routinely excised.
All comersAfter resectionAdjuvant capecitabine for six months (BILCAP; ASCO guideline 2019); chemoradiation considered for positive margins or node-positive disease.69

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.