Systemic Therapy for Biliary and Liver Neoplasms: Chemotherapy and Immunotherapy

Liver and biliary tract cancers represent some of the most therapeutically challenging malignancies, with rising global incidence. Hepatocellular carcinoma remains the most common primary liver cancer, typically developing in the context of cirrhosis and chronic liver injury, whereas biliary tract cancers encompassing gallbladder, intrahepatic, perihilar, and distal subtypes, arises from the biliary epithelium demonstrating aggressive biological behavior. Systemic therapy has undergone substantial evolution over the last decade, shifting from minimally effective cytotoxic chemotherapy toward a diverse therapeutic landscape that includes molecularly targeted agents, immune checkpoint inhibitors, antiangiogenic therapy, and combination regimens.