Biliary tract cancer (BTC) is a rare but highly aggressive malignancy arising from the bile ducts and gallbladder. Despite advances in diagnostic imaging and surgical techniques, most cases are diagnosed at an advanced stage, limiting curative options. Pharmacotherapy remains the mainstay of treatment for unresectable or metastatic disease. Recent developments in chemotherapy, targeted therapy, and immunotherapy have significantly improved patient outcomes and survival rates. Molecular profiling has led to the identification of actionable mutations, enabling personalized treatment approaches. Continued research into novel agents and combination therapies holds promise for further progress in the management of biliary tract cancer.