Abstract: Biliary tract cancer （BTC）mainly includes gallbladder cancers（GBC）， intrahepatic and extrahepatic cancers（ICC and ECC）with the rising morbidity of the first two kinds recently，and only about 10％ patients have opportunity of radical resection. Gemcitabine combined with cisplatin now has been recognized as the “golden standard” first-line regimen to those with advanced stage BTC. More and more clinical observations or practices presently show that other gecitabine-based combination chemotherapy regimens perhaps have advantages compared to with cisplatin-combination. This review focuses on how to optimize the gemcibatine-based first-line therapy of patients with advanced BTC.