胆道癌症的治疗格局正在迅速地改变。针对可操作的靶点FGFR和IDH1的抑制剂现在已被多个国家的治疗指南纳入晚期胆管癌患者的治疗方案。然而，仍存在一些未满足的需求，包括鉴定抵抗机制和涉及可能肿瘤测序的治疗策略。在本综述文章中，我们介绍了评估晚期胆管癌中FGFR、IDH、BRAF和HER2抑制剂的临床试验。我们还回顾了迄今为止描述的抵抗机制和克服这些机制的方法。本文选择的文章基于PubMed（2010-2022年）索引的研究报告。 在许多国家，胆道癌症的精准医学已经纳入了疾病的治疗格局。FGFR2融合和IDH1突变是这些癌症的可靶向治疗的第一驱动因素。HER2和BRAF可能是下一个驱动因素，并获得可能的肿瘤不可知或胆管癌特定的批准。ctDNA的出现可以改善这些临床试验中测序和招募的可达性。然而，应该考虑和解决检测融合的限制问题。

The treatment landscape of biliary cancers is rapidly changing. Inhibitors against the actionable targets FGFR and IDH1 are now being included in the treatment guidelines of multiple countries for patients with advanced cholangiocarcinoma. However, there remains an unmet need in identifying the mechanisms of resistance and treatment strategies involving possible tumor sequencing.In this review article, we address clinical trials evaluating FGFR, IDH, BRAF and HER2 inhibitors in advanced cholangiocarcinoma. We also review the mechanisms of resistance described thus far and approaches to overcome them. Articles selected for this review were based on reported studies indexed in PubMed (2010-2022).Precision medicine in biliary cancers has already been incorporated into the treatment landscape of the disease in many countries. Fusions of FGFR2 and mutations in IDH1 are the first drivers with targetable treatments approved in these cancers. HER2 and BRAF would be the next drivers with possible tumor-agnostic or cholangiocarcinoma-specific approvals. The advent of ctDNA could improve the accessibility of sequencing and recruitment in these clinical trials. However, limitations of detecting fusions should be considered and addressed in these platforms.