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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 | · | · | · |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diagnosis and staging | Contrast CT/MRI with MRCP; ERCP or EUS-guided biopsy; molecular profiling (DNA + RNA NGS) for all advanced disease; biliary drainage if jaundiced. | NCCN · Molecular testing recommended (category 2A) | 86 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Resectable | Surgery + adjuvant capecitabine. | NCCN Guidelines: Biliary Tract Cancers | - | |
| All comers | Resectable | Margin-negative resection (hepatectomy, Whipple, or radical cholecystectomy) with lymphadenectomy; adjuvant capecitabine 6 months (BILCAP). | NCCN · Capecitabine category 2A (preferred)ESMO-MCBS · B | 69 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Advanced | Gem-cis + PD-(L)1; targeted therapy by genotype second line. | NCCN Guidelines: Biliary Tract Cancers | 98 | |
| All comers | Unresectable perihilar in selected patients | Neoadjuvant chemoradiation then liver transplantation (Mayo protocol) at experienced centres. | NCCN · Category 2B, transplant centres only | 40 | |
| All comers | Advanced, first line | Gemcitabine-cisplatin + durvalumab (TOPAZ-1) or + pembrolizumab (KEYNOTE-966); zanidatamab added in HER2+ disease within HERIZON-BTC-302. | NCCN · Category 1 (preferred)ESMO-MCBS · TOPAZ-1 grade 3 | 98 | |
| All comers | Advanced, other alterations | Zenocutuzumab (NRG1 fusion, approved 2026); dabrafenib-trametinib (BRAF V600E); pembrolizumab or dostarlimab (MSI-H/dMMR); larotrectinib/entrectinib (NTRK). | NCCN · Category 2A (tumour-agnostic) | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Second-line, no target | FOLFOX (ABC-06, modest benefit); liposomal irinotecan/5-FU had conflicting results (NIFTY positive, NALIRICC negative); clinical trials preferred. | NCCN · FOLFOX category 1 | 99 | |
| FGFR | Advanced, FGFR2 fusion after chemotherapy | Pemigatinib or futibatinib; tinengotinib in FIRST-308 after progression. | NCCN · Category 2A | 71 | |
| HER2 | Advanced, HER2-positive after chemotherapy | Zanidatamab (IHC 3+ or amplified); trastuzumab deruxtecan (IHC 3+, tumour-agnostic). | NCCN · Category 2A | 97 | |
| IDH | Advanced, IDH1 mutation after chemotherapy | Ivosidenib (ClarIDHy). | NCCN · Category 1 | 89 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Locoregional (intrahepatic, liver-confined) | Y-90 radioembolisation, hepatic arterial infusion pump chemotherapy, or SBRT at specialised centres; no phase 3 proof of survival benefit. | NCCN · Category 2B | 40 |
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.