Patient description: A 45-year-old woman was referred to the emergency department with abdominal pain lasting about 4 days accompanied by nausea and 2 episodes of vomiting. The pain is localized to the epigastric region and radiates to the right upper quadrant. The pain is worsening after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and two C/sections. She has 2 children, and she is menopausal. She doesn't smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones and biliary sludge. The largest gallstone is 0.7cm. Surgery consultation recommends elective cholecystectomy.

Clinical trial eligibility criteria: eligible ages (years): 20.0-999.0,  Biliary Tract Cancer Histologically / cytologically verified, non-resectable, recurrent, or metastatic biliary tract carcinoma including intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma and gallbladder carcinoma. 2. Patients who were previously treated with one palliative chemotherapy (patients who recurred within 6 months after completion or during adjuvant chemotherapy are allowed) 3. Patients must have measurable or evaluable disease by 1.1 4. ECOG PS: 0, 1 5. Age ≥ 20 years 6. Adequate bone marrow function defined as: Hb ≥ 8 g/dl, ANC ≥ 1500/mcL, Platelets ≥ 100K/mcL 7. Adequate renal function defined as serum creatinine < 1.6 mg/dl and/or measured creatinine clearance from 24-hour urine collection of ≥ 60 ml/min 8. Adequate hepatic function defined as total bilirubin ≤ 2 mg/dl, ALT/AST ≤ 5 x ULN. 9. Ability to understand and the willingness to sign a written informed consent document  Evidence of another active cancer that may influence patient outcome, except for nonmelanoma skin carcinoma, melanoma in-situ, in-situ carcinoma of the cervix curatively treated, treated superficial bladder cancer, and adenocarcinoma of the prostate that has been surgically treated with a post-treatment PSA that is non-detectable. 2. Known brain metastases or primary central nervous system tumors with seizures that are not well controlled with standard medical therapy. 3. Uncontrolled intercurrent illness including, but not limited to psychiatric illness/social situations that would limit compliance with study requirements. 4. Known HIV positive patient 5. Significant cardiovascular disease including congestive heart failure (New York Heart Association Class II or higher) or active angina pectoris. 6. History of a myocardial infarction within 6 months. 7. History of a stroke or transient ischemic attack within 6 months. 8. Clinically significant peripheral vascular disease. 9. Major surgical procedure within 4 weeks. 10. Uncontrolled infection. 11. Pregnant (positive pregnancy test) 12. Breast-feeding should be discontinued if a nursing mother is to be treated on clinical trial. 13. History of any organ or bone marrow transplant. 14. Subjects who are taking medications that prolong QT interval and have a risk of Torsades de Pointes. 15. Subjects taking a medication that is a moderate or strong inhibitor or inducer of CYP3A4