Hepatobiliary

Regimen Options

Last Updated: 10/03/2025 See Details

NOTE: Best Supportive Care or Clinical Trial

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Hepatocellular Carcinoma (HCC)
Unresectable/Metastatic - Initial Therapy	lenvatinib	Low	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Kudo M, Finn RS, Qin S, et al. Lancet. 2018 Mar 24;391(10126):1163-1173.
	atezolizumab and bevacizumab (Child-Pugh Class A)	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Finn RS et al. N Engl J Med 2020;382:1894-905.
	tremelimumab and durvalumab (Child-Pugh Class A)	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers v.5.2022. Abou-Alfa GK et al. NEJM Evid 2022; 1 (8)
Subsequent Therapy	regorafenib	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Stivarga® (regorafenib) Package Insert. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2017, FDA Label. .
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial
Gallbladder / Cholangiocarcinoma
Adjuvant	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2023. Meyerhardt JA, et al. Dig Dis Sci. 2008;53(2):564-70. Doval DC, et al. Br J Cancer. 2004;90(8):1516-20.
	carboplatin and gemcitabine	Low	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Meyerhardt JA, et al. Dig Dis Sci. 2008;53(2):564-70. Doval DC, et al. Br J Cancer. 2004;90(8):1516-20.
	5FU (fluorouracil)	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Kresl JJ, et al. Int J Radiat Oncol Bio Phys. 2002;52(1):167-75. Czito BG, et al. Int J Radiat Oncol Bio Phys. 2005;62(4):1030-4.
	5FU (fluorouracil) and Radiation Therapy	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017
	capecitabine	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Das P, et al. Radiat Oncol. 2006;1:41.
	capecitabine and Radiation Therapy	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017
Unresectable/Metastatic - Initial and Subsequent Therapy	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Meyerhardt JA, et al. Dig Dis Sci. 2008;53(2):564-70. Doval DC, et al. Br J Cancer. 2004;90(8):1516-20.
	carboplatin and gemcitabine	Low	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Meyerhardt JA, et al. Dig Dis Sci. 2008;53(2):564-70. Doval DC, et al. Br J Cancer. 2004;90(8):1516-20.
	5FU (fluorouracil)	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Choi CW, et al. Am J Clin Oncol. 2000;23(4):425-8.
	capecitabine	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Patt YZ, et al. Cancer. 2004;101(3):578-86.
	gemcitabine	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Tsavaris N, et al. Invest New Drugs. 2004;22(2):193-8. Gallardo JO, et al. Ann Oncol. 2001;12(10):1403-6.
	durvalumab, gemcitabine and cisplatin - Initial Therapy only	Intermediate	High	NCCN Guidelines® for Hepatobiliary Cancers V.3.2023. Oh Do-Youn et al. NEJM Evid 2022;1(8)
	FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) - Subsequent Therapy only	Intermediate	Moderate	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Lamarca A et al. DOI: 10.1200/JCO.2019.37.15_suppl.4003 Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019) 4003-4003
	ivosidenib (IDH1 mutant-cholangiocarcinoma) - Subsequent Therapy only	Low	Low	NCCN Guidelines® for Hepatobiliary Cancers V.3.2017. Abou-Alfa GK. Lancet Oncol . 2020 Jun;21(6):79 6-807.
	Best Supportive Care or Clinical Trial	Not Applicable	Not applicable	Best Supportive Care or Clinical Trial

Hepatocellular Carcinoma (HCC)

Unresectable/Metastatic - Initial Therapy

Evolent Pathways

lenvatinib

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

atezolizumab and bevacizumab (Child-Pugh Class A)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

tremelimumab and durvalumab (Child-Pugh Class A)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Subsequent Therapy

Evolent Pathways

regorafenib

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

Gallbladder / Cholangiocarcinoma

Adjuvant

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

5FU (fluorouracil)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

5FU (fluorouracil) and Radiation Therapy

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine and Radiation Therapy

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Unresectable/Metastatic - Initial and Subsequent Therapy

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

5FU (fluorouracil)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

capecitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

durvalumab, gemcitabine and cisplatin - Initial Therapy only

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) - Subsequent Therapy only

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Evolent Pathways

ivosidenib (IDH1 mutant-cholangiocarcinoma) - Subsequent Therapy only

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care or Clinical Trial

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative	References
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Subsequent Therapy	zanidatamab-hrii HER2-positive biliary tract cancer	Alternative: fam-trastuzumab deruxtecan-nxki	NCCN Guidelines® for Hepatobiliary Cancers V.2.2025. Harding JJ et al. DOI: 10.1016/S1470-2045(23)00242-5

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Subsequent Therapy

Regimen

** zanidatamab-hrii ** HER2-positive biliary tract cancer

References

Pathways and Low-Value Regimens

Hepatobiliary