Gemcitabine and Nab-Paclitaxel Combined With Iparomlimab and Tuvorilimab for Advanced Gallbladder Cancer

Inclusion Criteria: * Signed informed consent. * Age 18-75 years. * ECOG performance status 0-2, Child-Pugh class A. * Histologically or cytologically confirmed advanced gallbladder cancer, deemed unresectable for R0 resection. * Adequate organ function: * ANC ≥1.5×10⁹/L, platelets ≥75×10⁹/L, hemoglobin ≥90 g/L. * Serum creatinine ≤1.2 mg/dL or creatinine clearance ≥60 mL/min. * Total bilirubin ≤1.5×ULN (≤3×ULN if liver metastases); AST/ALT ≤3×ULN (≤5×ULN if liver metastases). * Life expectancy ≥3 months. * Non-pregnant, non-lactating women and willingness to use contraception during and for 3 months after treatment. Exclusion Criteria: * Severe systemic infection or uncontrolled comorbidities (e.g., heart failure, thyroid disease, psychiatric disorders); active autoimmune disease requiring medication. * Known allergy or intolerance to chemotherapy agents. * Prior antitumor therapy (chemotherapy, radiotherapy, immunotherapy) within the past year, or history of other malignancies (except cured cervical carcinoma in situ or non-melanoma skin cancer). * Pregnancy, lactation, or unwillingness to use contraception. * Participation in another clinical trial within 30 days before the first dose. * Unwillingness to participate or inability to provide informed consent. * Any other condition that, in the investigator's judgment, may affect patient safety or compliance