Arkenau HT, et al. - In biomarker-unselected patients with previously treated advanced or metastatic biliary tract cancer (BTC), authors evaluated the safety and efficacy of ramucirumab, an IgG1 VEGFR-2 antagonist, with pembrolizumab, an IgG4 PD-1 antagonist. In patients with biomarker-unselected progressive BTC, limited clinical activity with infrequent grade 3–4 treatment-related adverse events (TRAEs) was demonstrated by ramucirumab-pembrolizumab. They noted 4% to be the objective response rate with the median progression-free survival and overall survival to be 1.6 months and 6.4 months, respectively.