A Study to Evaluate the Efficacy and Safety of Pemigatinib Versus Chemotherapy in Unresectable or Metastatic Cholangiocarcinoma

Inclusion Criteria:

• Male and female participants at least 18 years of age at the time of signing theinformed consent form (ICF).

• Histologically or cytologically confirmed cholangiocarcinoma that is previouslyuntreated and considered unresectable and/or metastatic (Stage IV per the AmericanJoint Committee on Cancer (AJCC) Cancer Staging Manual).

• Radiographically measurable or evaluable disease by CT or MRI per RECIST v1.1criteria.

• Eastern Cooperative Oncology Group performance status 0 to 1.

• Documented FGFR2 rearrangement.

• Willingness to avoid pregnancy or fathering children.

Exclusion Criteria:

• Received prior anticancer systemic therapy for unresectable and/or metastaticdisease (not including adjuvant/neo-adjuvant treatment completed at least 6 monthsprior to enrollment, and participants that have received treatment for locallyadvanced disease with trans-arterial chemoembolization or selective internalradiation therapy, if clear evidence of radiological progression is observed beforeenrollment, or enrolled as of Amendment 6 (or Amendment 5-JP2) and the participantreceived 1 cycle of gemcitabine plus cisplatin [the start of study drug {Cycle 1 Day 1} must be at least 14 days and ≤ 4 weeks {28 days} from the last dose ofgemcitabine plus cisplatin]).

• Child-Pugh B and C.

• Toxicities related to prior therapy(ies) must be Common Terminology Criteria forAdverse Events (CTCAE) v5.0 ≤ Grade 1 at the time of screening.

• Concurrent anticancer therapy, other than the therapies being tested in this study.

• Participant is a candidate for potentially curative surgery.

• Current evidence of clinically significant corneal (including but not limited tobullous/band keratopathy, corneal abrasion, inflammation/ulceration, andkeratoconjunctivitis) or retinal disorder (including but not limited to centralserous retinopathy, macular/retinal degeneration, diabetic retinopathy, retinaldetachment) as confirmed by ophthalmologic examination.

• Radiation therapy administered within 4 weeks of enrollment/randomization/first doseof study treatment.

• Known central nervous system (CNS) metastases or history of uncontrolled seizures.

• Known additional malignancy that is progressing or requires active treatment (exceptions: basal cell carcinoma of the skin, squamous cell carcinoma of the skin,or in situ cervical cancer that has undergone potentially curative therapy).

• Laboratory values at screening outside the protocol-defined range.

• History of calcium and phosphate hemostasis disorder or systemic mineral imbalancewith ectopic calcification of soft tissues (exception: commonly observedcalcifications in soft tissues, such as the skin, kidney, tendons or vessels due toinjury, disease, and aging, in the absence of systemic mineral imbalance).

• Significant gastrointestinal disorders that could interfere with absorption,metabolism, or excretion of pemigatinib.

• Clinically significant or uncontrolled cardiac disease.

• History or presence of an abnormal ECG, which, in the investigator's opinion, isclinically meaningful.

• Chronic or current active infectious disease requiring systemic antibiotics orantifungal or antiviral treatment within 2 weeks prior to enrollment (participantswith asymptomatic chronic infections on prophylactic treatment are allowed). Note:HIV-positive participants are allowed if all of the following criteria are met: CD4+count ≥ 300/µL, undetectable viral load, receiving antiretroviral therapy that doesnot interact with study drug, and no HIV/AIDS-associated opportunistic infection inthe last 12 months.

• Use of any potent CYP3A4 inhibitors or inducers or moderate CYP3A4 inducers within 14 days or 5 half-lives (whichever is longer) before the first dose of studytreatment. Note: Moderate CYP3A4 inhibitors are not prohibited

• Known hypersensitivity or severe reaction to pemigatinib, gemcitabine, cisplatin, ortheir excipients.

• Inadequate recovery from toxicity and/or complications from a major surgery beforestarting therapy.