Gemcitabine has shown some promise as a potential chemotherapeutic agent in the treatment of cholangiocarcinoma. A multicenter retrospective analysis out of Japan examining a multitude of different CT regimens in patients with intrahepatic, extrahepatic or gallbladder carcinomas reported gemcitabine was the most effective treatment, with a reduction in mortality by about 50%.7 Fifty-eight patients of the 413 identified in this study were treated with gemcitabine, 6.9% showed partial response, 50% remained stable, and 39.7% progressed despite therapy. Median survival was 8.05 months with a hazard ratio (HR) of 0.50 (95% confidence interval 0.35-0.72). Sixteen out of the 58 patients treated with gemcitabine had extrahepatic cholangiocarcinoma. In numerous phase II trials of gemcitabine as a single agent, response rates have ranged from 6-30%, with greater than 50% of treated patients having either a partial response or stable disease. 7-12 Median survival (MS) has ranged from 6.5-14 months in these trials. In 2008, guidelines for CT in biliary tract cancers were published in the Journal of Hepatobiliary and Pancreatic Surgery.13 Seven trials using gemcitabine as a single agent were identified, with response rates ranging from 0-36% and MS ranging from 4.6-14 months. In this article the use of gemcitabine in unresectable cancers of the biliary tract was given a recommendation level C1, meaning that its use may be considered, although there is a lack of high-level evidence.13