Intervention: MK-2206
Trial phase: Phase 2
SMILES: NC1(c2ccc(-c3nc4ccn5c(=O)[nH]nc5c4cc3-c3ccccc3)cc2)CCC1
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 8
Group description: Patients receive Akt inhibitor MK2206 PO on days 1, 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Akt Inhibitor MK2206: Given PO

Diagnostic Laboratory Biomarker Analysis: Correlative studies

Pharmacological Study: Correlative studies
Eligibility criteria:
Inclusion Criteria:

Patients must have histologically confirmed biliary tract carcinoma that is surgically unresectable

Cytological confirmation is not allowed on this study, as tissue is needed for correlative science analysis
Either fresh-frozen tissue (FFT) or paraffin-embedded tissue blocks (PETB) will be required from patients before enrolling on this study
No biopsies will be required unless there is insufficient tissue or if the PETB available is more than 12 months old

Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 10 mm with spiral CT scan (CT scan slice thickness no greater than 5 mm)

Malignant lymph nodes will be considered measurable if they are ≥ 15 mm in short axis

Patients must have received one prior therapy for metastatic disease

No prior Akt inhibitors allowed
Patients with known brain metastases should be excluded from this clinical trial
Life expectancy greater than 12 weeks
Eastern Cooperative Oncology Group (ECOG) performance status (PS) =<2 (Karnofsky >= 60%)
Leukocytes >= 3,000/mcL
Absolute neutrophil count (ANC) >= 1,500/mcL
Platelet count >= 100,000/mcL
Total bilirubin =< 1.5 x institutional upper limit of normal (IULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase [SGPT] =< 2.5 x IULN
Creatinine within normal institutional limits OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal (measured or calculated using the Cockroft-Gualt formula)
Women of childbearing potential and men must use two forms of contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
Not pregnant or nursing
Able to swallow oral tablets
No history of allergic reactions attributed to compounds of similar chemical or biologic composition to Akt Inhibitor MK2206 (MK2206) or other agents used in the study
Patients with diabetes or in risk for hyperglycemia should not be excluded from trials with MK2206, but the hyperglycemia should be well controlled on oral agents before the patient enters the trial
Cardiovascular: baseline QTcF > 450 msec (male) or QTcF > 470 msec (female) will exclude patients from entry on study
Patients with clinically significant bundle branch block or pre-existing clinically significant bradycardia will be excluded from the study
No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection; symptomatic congestive heart failure; unstable angina pectoris; cardiac arrhythmia; or psychiatric illness/social situations that would limit compliance with study requirements
No concurrent grapefruit or grapefruit juice

For patients having prior cryotherapy, radiofrequency ablation, ethanol injection, transarterial chemoembolization (TACE), or photodynamic therapy, the following criteria must be met:

6 weeks has elapsed since that therapy
Indicator lesion(s) is/are outside the area of prior treatment or, if the only indicator lesion is inside the prior treatment area, there must be clear evidence of disease progression associated with that lesion
Edges of the indicator lesion are clearly distinct on CT scanning
Prior radiation therapy with or without the use of a fluoropyrimidine as a radiosensitizer in the adjuvant setting will be allowed on study if > 12 weeks have elapsed since therapy
Prior palliative radiation therapy will allowed as long as > 4 weeks have elapsed since therapy
No patients who have had chemotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Patients may not be receiving any other investigational agents
Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible
Patients receiving any medications or substances that are inhibitors or inducers of CYP 450 3A4 are ineligible