Precision Oncology Targets in Biliary Tract Cancer

SIMPLE SUMMARY: Biliary tract cancer is rare in the US but remains a highly lethal cancer. While the standard of care in the first-line, metastatic setting is well-established, no second-line regimen has been clearly defined as the gold standard. Many novel biomarker-targeted therapies have emerged and shown promise, even in treatment-refractory patients. Here, we seek to provide updates on the landscape of targeted therapies available for the treatment of advanced biliary tract cancer. ABSTRACT: Targeted therapies in biliary tract cancer (BTC) are emerging as options for patients not who do not respond to first-line treatment. Agents acting on tumor-specific oncogenes in BTC may target fibroblast growth factor receptor 2 (FGFR2), isocitrate dehydrogenase (IDH), B-raf kinase (BRAF), and human epidermal growth factor receptor 2 (HER-2). Additionally, given the heterogeneous genetic landscape of advanced BTCs, many harbor genetic aberrations that are common among solid tumors, including RET fusions, tropomyosin receptor kinase (TRK) fusions, and high tumor mutational burden (TMB). This review aims to provide updates on the evolving array of therapeutics available, and to summarize promising works on the horizon.