Unmet needs in CCA — 3 of 3

ESMO Clinical Practice Guidelines provide key recommendations for managing CCA

Molecular analysis should be carried out before or during 1L therapy to evaluate options for second and higher lines of treatment in advanced disease12


A chart showing the treatment algorithm

*Not yet EMA approved but FDA approved; Clinical trial recommended when available; Molecular profiling should be performed before/during 1L therapy. Gene panel should include FGFR2, IDH1, HER2/neu and BRAF to test for hotspot mutations, but may also include genes such as NTRK and c-MET; §Cisplatin–gemcitabine ± durvalumab is recommended for 1L treatment; consider gemcitabine monotherapy in patients with a compromised performance status or significant debility who are at risk of toxicity from platinum-containing chemotherapy regimens; Reconsider surgery in the event of adequate response to treatment; EMA and FDA approved; **Drug will be permanently discontinued from 31 March 2023;2 ††EMA approved for MSI-H/dMMR BTC and FDA approved for all MSI-H/dMMR solid tumours; ‡‡Anti–PD-1 therapy is recommended for patients with MSI-H/dMMR who have not been treated with 1L immunotherapy; §§Not yet EMA approved and not yet FDA approved.

Figure adapted from Annals of Oncology, Volume 34/Issue 2, Vogel A, et al. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up, P127–40, with permission from the European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.