 Recently the first results of a randomized phase II study of gemcitabine and oxaliplatin GEMOX alone or in combination with cetuximab in patients with advanced biliary cancer have been reported Malka et al. 2009. The primary objective of the study was a 4-month PFS rate of more than 60 in the experimental arm with cetuximab. The included patients were not monitored for RAS or B-RAF mutations. However compared to GEMOX chemotherapy n51, GEMOXcetuximab n50 showed an increased 4-month PFS-rate 50 versus 61 and an improved median PFS 5 versus 7 months. This is the first evidence from a randomized trial that anti-EGFR therapy may be effective for patients with cholangiocarcinomas and gallbladder carcinomas. 