Molecular Profiling of Advanced Biliary Tract Cancers

Inclusion Criteria:

* Patients must have a histological or radiological diagnosis of inoperable or metastatic biliary tract cancer (BTC).
* Patient must have a tumor lesion that is amenable to a core needle biopsy as judged by a staff radiologist.
* Patients must have a measurable lesion by RECIST 1.1 in addition to the lesion that is going to be biopsied.
* Patients must be fit enough to safely undergo a tumor biopsy as judged by the investigator.
* Eastern Cooperative Group (ECOG) performance status ≤ 1 (Karnofsky ≥60%).
* Life expectancy of greater than 90 days, as judged by the investigator.
* Within 14 days of the proposed biopsy date, patients must have normal organ and marrow function.
* Patients must undergo systemic treatment with gemcitabine or 5-FU based regimens as first line standard systemic palliative treatment with or without other investigational agents within a clinical trial.
* Ability to understand and willing to sign a written informed consent document.

Exclusion Criteria:

* Patients with one or more contraindications to tumor biopsy.
* Patients who have had prior systemic treatment (chemotherapy or any other anti-cancer agent) in the advanced setting.
* Patients who are currently on anti-cancer treatment including chemotherapy.
* Patients with known brain metastases are excluded from participation in this clinical study.
* Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures