Pancreaticobiliary cancers remain challenging to be treated due to aggressive biology and heterogeneous molecular patterns. Chemotherapy remains the backbone therapy, with two lines available in each cancer. Using targeted therapies in unselected populations has led to complete failure while currently used immunotherapy with anti-PD1 can only be active in instable tumours (MSI-High), a rare condition in these cancers. As recently reported, targeting specific genes in pancreaticobiliary cancers may significantly improve tumour control and offer new ways to manage them, in addition to conventional chemotherapies usually proposed in front line. Consequently, it is now more and more recommended to perform genetic and genomic testing of these tumours, searching for new druggable targets. Dedicated trials focusing on such enriched populations are currently ongoing.

(BELG J MED ONCOL 2020;14(6):274-9)