Ramucirumab in Treating Patients With Advanced or Metastatic, Previously Treated Biliary Cancers That Cannot Be Removed by Surgery

Inclusion Criteria

• •Patient must have cholangiocarcinoma, gallbladder cancer or adenocarcinoma on liver biopsy with clinical features consistent with biliary primary/cholangiocarcinoma
• •Metastatic or unresectable disease documented on diagnostic imaging studies
• •Must have received at least one regimen containing gemcitabine chemotherapy
• •Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1
• •Total bilirubin =\< 1.5 mg/dL (25.65 mol/L)
• •Aspartate transaminase (AST) and alanine transaminase (ALT) =\< 3.0 times the upper limit of normal (\[ULN\]; or 5.0 times the ULN in the setting of liver metastases)
• •Absolute neutrophil count (ANC) \>= 1000/uL
• •Hemoglobin \>= 9 g/dL (5.58 mmol/L)
• •Platelets \>= 100,000/uL
• •The patient does not have:
• •* Cirrhosis at a level of Child-Pugh B (or worse) or
• •* Cirrhosis (any degree) and a history of hepatic encephalopathy or clinically meaningful ascites resulting from cirrhosis; clinically meaningful ascites is defined as ascites from cirrhosis requiring diuretics or paracentesis
• •Serum creatinine =\< 1.5 times the ULN or
• •Creatinine clearance (measured via 24-hour urine collection) \>= 40 mL/minute (that is, if serum creatinine is \> 1.5 times the ULN, a 24-hour urine collection to calculate creatinine clearance must be performed
• •The patient's urinary protein is =\< 1 positive (+) (=\< 30-100 mg/dl) on dipstick or routine urinalysis (urinary analysis \[UA\]; if urine dipstick or routine analysis is \>= 2+ (\>=100-300 mg/dl), a 24-hour urine collection for protein must demonstrate \< 1000 mg of protein in 24 hours to allow participation in this protocol)
• •The patient must have adequate coagulation function as defined by international normalized ratio (INR) =\< 1.5 and
• •Partial thromboplastin time (PTT) (PTT/activated partial thromboplastin time \[aPTT\]) \< 1.5 x ULN)
• •Patients on full-dose anticoagulation must be on a stable dose (minimum duration 14 days) of oral anticoagulant or low molecular weight heparin; if receiving warfarin, the patient must have an INR =\< 3.0 and no active bleeding (that is, no bleeding within 14 days prior to first dose of protocol therapy) or pathological condition present that carries a high risk of bleeding (for example, tumor involving major vessels or known varices)
• •The patient, if sexually active, must be postmenopausal, surgically sterile, or using effective contraception (hormonal or barrier methods)
• •Female patients of childbearing potential must have a negative serum pregnancy test within 7 days
• •Patients must sign an informed consent and authorization indicating that they are aware of the investigational nature of this study and the known risks involved
• •In the ten patient expanded cohort, patients diagnosed with deoxyribonucleic acid (DNA) repair or FGFR genetic aberrations will be enrolled