Molecular Targets and Emerging Therapies for Advanced Gallbladder Cancer

Simple Summary: Biliary tract cancers (BTCs) are rare tumors with devastating prognosis. Gallbladder cancer (GBC) is the most common BTC, and even though recent advances have been carried out in the field of clinical management, research for molecular targets for precision medicine is proceeding at slow steps. This review discuss the molecular targets highlighted to date, focusing on clinical trials exploring the efficacy of precision medicine and immunotherapeutic compounds for the treatment of advanced GBC. Points of strength and weakness of each molecular biomarker are discussed, designing new landscapes for new therapeutic approaches for this malignancy, and suggesting new roles for cytotoxic agents, to date considered the gold standard for patients' clinical management. Biliary tract cancers (BTCs), for their low incidence, have been often considered together. Gallbladder cancer (GBC) is the most common biliary tract malignancy, characterized by late diagnosis and poor prognosis, and although it is considered a rare tumor in western countries, other areas of the world show considerable incidence rates. In 2010, results from the large phase III ABC-02 clinical trial on GBC identified the gemcitabine and cisplatin combination as the most effective first-line regimen for both GBC and other BTCs. Since then, various systemic therapies have proven active in BTCs in both first- and second-line settings. Molecular profiling has highlighted important genetic differences between GBC and other BTCs, opening new ways for targeted therapy in advanced disease where standard chemotherapies show marginal benefit. Genome-wide data analysis have shown that GBC molecular landscape offer possible strategies for precision medicine approaches, and a better molecular understanding of the GBC is needed to better stratify patients for treatment. In this review, we discuss the molecular targetable agents for GBC, including the results that emerged by clinical trials exploring new treatment strategies.