Gemcitabine Hydrochloride, Cisplatin, and Yttrium Y 90-TARE in Treating Patients with Liver Cancer That Cannot Be Removed by Surgery

Inclusion Criteria

• Core needle biopsy or surgical specimen that confirms ICC; patients must be determined to be unresectable by a multidisciplinary team that includes a hepatobiliary surgeon
• Prior treatment: * No prior liver radiation therapy or immunotherapy for cholangiocarcinoma * Only one previous single agent chemotherapy for ICC allowed * Patient may have prior liver resection
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2
• Child-Pugh score of A
• Life expectancy of greater than 4 months
• Absolute neutrophil count (ANC) >= 1.5 K/CUMM
• Platelet (PLT) >= 100 K/CUMM
• Bilirubin =< 2.0 mg/dL
• Creatinine =< 1.5 mg/dL
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 5 X upper limit of normal (ULN)
• Alkaline phosphatase (Alk phos) =< 5 X ULN
• International normalized ratio (INR) =< 2.0
• All patients must be informed of the investigational nature of this study and must have the ability to understand and the willingness to sign a written informed consent document
• Willingness to use effective contraceptive methods during the study; female patients may participate if patient is either not of childbearing potential (defined as postmenopausal for > 1 year or surgically sterile) or is practicing two forms of contraception; sexually active male participants must agree to use a physical barrier method (male latex rubber condom with or without spermicide)
• Patients with well controlled human immunodeficiency virus (HIV) infection are eligible if their cluster of differentiation (CD)4 count is > 499/cu mm and viral load is < 50 copies/ml
• Pre-certification for the 90Y TARE should be performed prior to enrollment on this study

Exclusion Criteria

• Patients who have had major surgery within 4 weeks prior to study registration or those who have not recovered from complications from a surgery more than 4 weeks prior to registration
• Patients may not be receiving any other investigational and/or anti-cancer agents
• Patients must not have any grade III/IV cardiac disease as defined by the New York Heart Association (NYHA) criteria unstable angina pectoris, or myocardial infarction within 6 months of registration; patients with a history of myocardial infarction or irregular heart rate within 6 months prior to registration should be evaluated by a cardiologist prior to registration
• Patients must NOT have liver disease such as cirrhosis or sever hepatic impairment as defined by Child-Pugh class B or C
• Pregnant women are excluded from this study; breastfeeding should be discontinued