Biliary tract cancers (BTCs) represent a heterogeneous group that includes intrahepatic cholangiocarcinomas (CCAs), perihilar-CCAs or Klatskin tumors, extrahepatic-CCAs, and gallbladder adenocarcinoma. These entities have distinct demographics, risk factors, clinical presentation, and molecular characteristics. In advanced BTCs, the recommendations are mainly supporting a doublet chemotherapy regimen using cisplatin/gemcitabine (CisGem) with a 5-year overall survival rate close to 5% and median overall survival (mOS) of less than a year. The lack of overall efficacy stresses the need for personalized therapies. Recently, whole-genome and transcriptome sequencing highlighted the diversity of BTCs' subtypes. Distinct genetic alterations were retrieved according to the localization, with a high rate of potentially actionable alterations. Targeted therapies and immunotherapy have since then been tested for BTCs, trying to propose a more personalized treatment. This review describes the different therapeutic options, validated and in development, for patients with advanced BTCs.

中文翻译：

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晚期胆道癌的最佳治疗选择：化学疗法，靶向疗法或免疫疗法。

胆道癌（BTC）代表异类，包括肝内胆管癌（CCA），肝门-CCA或Klatskin肿瘤，肝外-CCA和胆囊腺癌。这些实体具有不同的人口统计学，风险因素，临床表现和分子特征。在晚期BTC中，建议主要支持使用顺铂/吉西他滨（CisGem）的双联化疗方案，其5年总生存率接近5％，中位总生存期（mOS）不到一年。缺乏整体功效强调了个性化疗法的需求。最近，全基因组和转录组测序突显了BTCs亚型的多样性。根据定位检索出明显的遗传变异，且潜在的可操作变异发生率很高。从那以后，针对靶向治疗和免疫疗法的BTC进行了测试，试图提出一种更具个性化的治疗方法。这篇综述描述了已验证的和正在开发的针对晚期BTC患者的不同治疗选择。