Background/Aim: Cholangiocarcinoma (CCA) is an aggressive tumor with limited treatment options especially in 2nd line or later treatments. Targeting fibroblast growth factor receptor (FGFR) 2 has recently emerged as a promising treatment option for patients with CCA harboring FGFR2-fusion. This study investigated the antitumor activities of tasurgratinib as an orally available FGFR1-3 inhibitor, in preclinical FGFR2-driven CCA models. Materials and Methods: Antitumor activities of tasurgratinib were examined in vitro and in vivo using NIH/3T3 cells expressing FGFR2-fusion as FGFR2-driven CCA models, and in vivo using a CCA patient-derived xenograft model. The molecular mechanism of action of tasurgratinib was elucidated through co-crystal structure analysis with FGFR1, manual complex model analysis with FGFR2, and binding kinetics analysis with FGFR2. Furthermore, the cell-based inhibitory activities against acquired resistant FGFR2 mutations in patients with CCA treated with FGFR inhibitors were evaluated. Results: Tasurgratinib showed antitumor activity in preclinical FGFR2-driven CCA models by inhibiting the FGFR signaling pathway in vitro and in vivo. Furthermore, cell-based target engagement assays indicated that tasurgratinib had potent inhibitory activities against FGFR2 mutations, such as N549H/K, which are the major acquired mutations in CCA. We also confirmed that tasurgratinib exhibited fast association and slow dissociation kinetics with FGFR2, binding to the ATP-binding site and the neighboring region, and adopting an Asp-Phe-Gly (DFG)-"in" conformation. Conclusion: These data demonstrate the therapeutic potential of tasurgratinib in FGFR2-driven CCA and provide molecular mechanistic insights into its unique inhibitory profile against secondary FGFR2 resistance mutations in patients with CCA treated with FGFR inhibitors.Cholangiocarcinoma (CCA) is the second-most common primary hepatic malignancy worldwide. It accounts for approximately 30% of all primary liver cancers and is associated with a high mortality rate owing to few symptoms in its early stages and frequent diagnosis at an advanced stage (1, 2). Incidence rates have increased over the past decade, with an annual incidence of 2000-3000 cases in the United States (3). However, the incidence of CCA is much higher in Asian countries, including Japan and China (4). CCA is often diagnosed after the disease significantly progresses when it is unresectable. In addition to gemcitabine plus cisplatin as the standard of care, durvalumab plus gemcitabine and cisplatin was recently approved and recommended as first-line treatment for patients with advanced stage; however, the prognosis remains poor, and more effective treatment strategies are warranted (5, 6).The Fibroblast growth factor receptor (FGFR) family of tyrosine kinases receptors consists of four genes that encode transmembrane receptors that bind to FGF on the extracellular domain. Upon binding to a ligand, a signaling cascade induces several cellular functions, including the proliferation, s...