Background: iCCA is the 2nd most common liver malignancy and with a poor patient prognosis. The ABC-02 study established gemcitabine+cisplatin (gem-cis) as the standard of care (SOC) in 1st line (1L) systemic chemotherapy (CT). The objective was to examine the treatment (tx) patterns and time trends in the tx received by patients (pts) with iCCA in the United States before and after ABC-02 study was published. Methods: Retrospective data from the Optum Research Database, which included commercial and Medicare Advantage health plan members between January 1, 2006 and June 30, 2018, were used. Eligible pts were aged ≥ 18 years; had ≥ 2 nondiagnostic claims of primary iCCA diagnosis (International Classification of Disease [ICD]-9: 155.1 or ICD-10: C22.1) in the identification period (July 01, 2006–March 31, 2018); and had 6 months continuous enrollment prior to and ≥ 3 months follow-up (or less due to death) from the date of first diagnosis. Tx patterns in the periods before and after ABC-02 data availability (2010) were summarized. Time to subsequent tx was defined as time from the last claim for the current tx to the first claim for the next tx. Results: The study included 2706 pts. Mean age (standard deviation) was 68 (12.1) years, 45% were female, and 42% presented with metastatic disease (Table 1). Notable comorbid conditions were liver disease (74%), chronic kidney disease (23%) and acute renal failure (18%). The median follow-up time was 224 days. Overall, 50% of the pts received systemic CT between 2006 and 2018. The proportion of pts who received CT was 14% and 35% in periods before and after ABC-02, respectively (Figure 1). The use of gem-cis in 1L was 10% and 29% in these periods, respectively. Among those who received a tx, 38% received a 2nd-line tx. Of these, 36% received a 3rd-line tx. The most common tx received in 2nd- and 3rd-line after ABC-02 were capecitabine (12%) and fluorouracil/irinotecan/leucovorin (7%). The mean time to subsequent line of tx was approximately 3.3 months for both 2nd- and 3rd-line tx. Conclusions: There appears to be a significant unmet medical need among pts diagnosed with iCCA, with only 50% having received systemic CT. After ABC-02, a 3-fold increase in gem-cis use in 1L was observed. However, gem-cis was only received by 1/3 of pts, perhaps limited by renal comorbidities. A short time to subsequent therapies observed in this study may be indicative of rapid progressive disease in patients with iCCA.