gemcitabine + cisplatin + nab-paclitaxel + rilvegostomig

This is an investigational combination regimen consisting of three chemotherapeutic agents—gemcitabine, cisplatin, and nab-paclitaxel—together with rilvegostomig, a bispecific monoclonal antibody targeting PD-1 and TIGIT. Gemcitabine is a nucleoside analog that inhibits DNA synthesis; cisplatin is a platinum-based agent causing DNA crosslinking and apoptosis; nab-paclitaxel (nanoparticle albumin-bound paclitaxel) stabilizes microtubules to inhibit cell division. Rilvegostomig blocks both the programmed cell death protein 1 receptor (PD-1) and T-cell immunoreceptor with Ig and ITIM domains (TIGIT), enhancing anti-tumor immune responses by preventing inhibitory signaling in T cells. This combination is under clinical investigation for use as adjuvant therapy in biliary tract cancer after resection, among other solid tumors[1][2][3][6].