Cholangiocarcinoma Clinical Trial Landscape

The cholangiocarcinoma trial landscape in 2026

Cholangiocarcinoma has transformed from a therapeutically neglected malignancy to one of the most molecularly complex and commercially active rare oncology settings. The approvals of pemigatinib and infigratinib for FGFR2-fused intrahepatic CCA (iCCA), followed by ivosidenib for IDH1-mutated CCA, opened the era of molecularly targeted therapy in bile duct cancer. NTRK, BRAF, RET, and HER2 alterations have added additional actionable targets, making CCA one of the highest-density precision oncology settings in solid tumors.

The current competitive frontier is second-generation FGFR2 inhibitors overcoming resistance to first-generation agents, combinations of IO with targeted therapy, and — most recently — KRAS G12C-targeting agents entering CCA after the KRAS alteration was found in a meaningful fraction of extrahepatic CCA. For any BD, medical affairs, or investment professional following this space, the trial landscape requires daily attention.

Key CCA program categories to monitor:

• FGFR2 (iCCA-specific): Second-generation FGFR inhibitors (RLY-4008/lirafugratinib, NVL-520), combinations, and post-pemigatinib resistance settings
• IDH1 (iCCA/eCCA): Programs following ivosidenib, including combinations with venetoclax and IO agents
• KRAS G12C (eCCA/gCCA): Sotorasib and adagrasib combination studies, plus next-generation KRAS inhibitors
• Immunotherapy combinations: First-line durvalumab plus TOPAZ-1 standard of care vs. novel IO combinations
• ERBB2/HER2: Zanidatamab and other HER2-directed agents in HER2-amplified CCA (5–10% of cases)
• Pan-biomarker agnostic: NTRK (larotrectinib/entrectinib), BRAF V600E (dabrafenib/trametinib), RET inhibitors

What DataLookout monitors for cholangiocarcinoma

Configure your profile with keywords as specific or broad as your intelligence needs require. Examples:

• By histology/anatomy: "intrahepatic cholangiocarcinoma", "extrahepatic CCA", "perihilar bile duct cancer", "gallbladder cancer"
• By molecular target: "FGFR2 biliary", "IDH1 cholangiocarcinoma", "KRAS CCA", "HER2 bile duct"
• By mechanism: "FGFR inhibitor CCA", "IDH1 inhibitor biliary", "PD-L1 cholangiocarcinoma"
• By line of therapy: "first-line CCA", "second-line cholangiocarcinoma", "refractory bile duct cancer"

Who uses CCA trial monitoring

Oncology BD professionals

The cholangiocarcinoma space has attracted significant licensing activity. Relay Therapeutics' lirafugratinib (RLY-4008), a highly selective FGFR2 inhibitor, was a notable BD transaction. Janssen acquired a strong position through the FGFR inhibitor erdafitinib. Monitoring new Phase 2 trial initiations in FGFR2, IDH1, or KRAS CCA subsets allows BD teams to identify early-stage assets before clinical data becomes widely publicized.

Healthcare investors

CCA assets have driven significant valuation events. A Phase 3 trial initiation for a next-generation FGFR2 inhibitor in the post-pemigatinib setting, or a Phase 2 readout in KRAS G12C-mutated extrahepatic CCA, can drive material stock moves. Daily trial monitoring keeps analysts ahead of the news cycle.

Clinical development and medical affairs

Companies developing IO combinations in CCA following TOPAZ-1 and KEYNOTE-966 approvals monitor competitive Phase 3 activity continuously. The question of which IO combination will replace or complement gemcitabine/cisplatin/durvalumab as first-line standard of care is playing out in multiple ongoing Phase 3 trials.

Current cholangiocarcinoma trial activity (as of early 2026)

Based on ClinicalTrials.gov data updated daily by DataLookout:

The second-generation FGFR inhibitor race is the most commercially critical competition in iCCA. After first-generation approvals (pemigatinib, infigratinib), acquired resistance via FGFR2 kinase domain mutations became the defining unmet need. Relay Therapeutics' lirafugratinib (RLY-4008) showed response rates in pemigatinib-pretreated patients in Phase 1/2, and its Phase 3 study (REFRACT-1) is recruiting. NVL-520 (Nuvalent) is another highly selective entrant. This is the pivotal competitive battleground in iCCA.

The IDH1 space is evolving beyond ivosidenib monotherapy. Multiple trials are combining ivosidenib with venetoclax (exploiting IDH1-driven BCL-2 dependency) and with immune checkpoint inhibitors. The INDIGO trial explored nivo combinations. IDH1 affects 10–15% of iCCA patients, making this a meaningful but still molecularly enriched segment.

Frequently asked questions