The first 60 days: Biliary tract cancer (all types)

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• SurgeonNamed in the standard of care for: Resectable disease.
• Medical oncologistNamed in the standard of care for: Resectable disease, Advanced disease, Second line by biology.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Resectable disease

   Surgery followed by six months of capecitabine (BILCAP).

   BILCAPCapecitabine
2. 2.Advanced disease

   Gemcitabine-cisplatin with durvalumab (TOPAZ-1) or pembrolizumab; targeted therapy for FGFR2 and IDH1 alterations on progression.

   Biliary tract cancer (cholangiocarcinoma)GemcitabineCisplatinDurvalumab
3. 3.Second line by biology

   Pemigatinib or futibatinib for FGFR2 fusions, ivosidenib for IDH1 mutations, FOLFOX otherwise.

   PemigatinibFutibatinibIvosidenibOxaliplatin

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• ACTICCA-1Phase 3 · active · NCT02170090Adjuvant gemcitabine and cisplatin for 24 weeks versus standard of care (observation, later capecitabine) after curative-intent resection of cholangiocarcinoma or muscle-invasive gallbladder carcinoma, in two separate cohorts
• Evaluating Novel Therapies in ctDNA Positive GI CancersPhase 3 · recruiting · NCT05482516Evaluating Novel Therapies and ctDNA as a Marker in Curatively-Treated Gastrointestinal Cancers With Microscopic Residual Disease
• Investigating Precision Medicine in the Adjuvant Setting in Biliary Tract CancerPhase 3 · planned · NCT07745296Investigating Precision Medicine in the Adjuvant Setting: a Phase 3 Clinical Trial in Biliary Tract Cancer
• SAFIR-ABC10Phase 3 · recruiting · NCT05615818Advanced biliary cancer (intrahepatic, perihilar or distal cholangiocarcinoma, or gallbladder carcinoma) after induction gemcitabine and cisplatin: molecular targeted maintenance therapy matched to the tumour's alteration versus standard of care, international platform phase 3
• Trastuzumab Plus Chemotherapy vs Chemotherapy Alone in First-line HER2 Positive Advanced Biliary Tract Cancer PatientsPhase 3 · recruiting · NCT07062263Trastuzumab Plus Chemotherapy vs Chemotherapy Alone in First-line HER2 Positive Advanced Biliary Tract Cancer Patients - a Randomized Non-blinded Two-arm Phase III Prospective Clinical Trial (TAB-2 Study).

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Biliary tract cancer (all types): the full pageBiliary tract cancers arise in the bile ducts inside or outside the liver, the gallbladder or the ampulla where the duct meets the bowel. They share short survival and the same first-line chemotherapy with immunotherapy, but differ in causes and in the targetable mutations they carry. Each has its own page.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.