What "adjuvant" therapy would you consider in patients with gallbladder cancer with liver metastases that are resected upfront?

The scenario is that of already metastatic disease. Adjuvant therapy does not apply. The only choice is patience, hoping for no recurrence. While knowing recurrence is definite, would wait to treat when recurrence occurs. Close monitoring and support would be best!

The TOPAZ regimen would not be appropriate here given that the eligible population had unresectable metastatic cholangiocarcinoma. A critical part of the TOPAZ regimen is the ability to carefully monitor the patient for response or progression which, in the adjuvant setting cannot be done. One could consider the SWOG0809/ @Dr. First Last regimen with chemotherapy and chemoradiation assuming that this metastatic disease was resected with an R0 resection and the patient is NED.