Biliary tract cancer (all types): lines of therapy

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3 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers
Early / localised	1
Advanced, first line	1
Second line	1

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Resectable disease	Surgery followed by six months of capecitabine (BILCAP).	BILCAPCapecitabine		83

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Advanced disease	Gemcitabine-cisplatin with durvalumab (TOPAZ-1) or pembrolizumab; targeted therapy for FGFR2 and IDH1 alterations on progression.	Biliary tract cancer (cholangiocarcinoma)GemcitabineCisplatinDurvalumab		98

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Second line by biology	Pemigatinib or futibatinib for FGFR2 fusions, ivosidenib for IDH1 mutations, FOLFOX otherwise.	PemigatinibFutibatinibIvosidenibOxaliplatin		90

Sequence and caution pairings

CautionApproved

Caution: DXd ADC + agents with pneumonitis risk

Enhertu and its DXd cousins can inflame the lungs; combining them with immunotherapy, radiation, or mTOR inhibitors stacks that risk.

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.