Clinical Implications, Open Questions, and Looking Ahead

The faculty synthesize the evidence into clinical positioning and outline the questions that remain open. They summarize that durvalumab plus gemcitabine and cisplatin is FDA approved and guideline-endorsed as first-line therapy for unresectable or metastatic biliary tract cancer, supported by long-term follow-up without new safety signals and by independent real-world data confirming that efficacy translates to routine practice. The panel then identifies unresolved issues, beginning with the optimal duration of the immunotherapy and chemotherapy components. The absence of a validated predictive biomarker is revisited. Best sequencing strategy after progression is also unsettled, although the panel emphasizes targeting mutations in real-world practice. Looking ahead, the faculty discuss combination approaches in early-phase investigation​.