Updates in the Management of Biliary Tract Cancers

In 2020, there were no FDA-approved drugs available for biliary tract cancer (BTC). Fast forward to 2025, and BTC has received 5 FDA approvals within 3 years and several designations in the NCCN Guidelines for BTCs. Capecitabine remains the standard adjuvant therapy, and a feasibility trial of a neoadjuvant chemotherapy combination has paved the way for ongoing studies in this space. The establishment of 2 chemotherapy regimens as standard of care in the second-line setting, along with 2 positive first-line trials of chemoimmunotherapy, has resulted in their inclusion in the NCCN Guidelines for the management of systemic disease. Several targeted agents, such as those directed at IDH1 , BRAF V600E, FGFR2 , and HER2, are also now recommended in the subsequent-line setting.