Inclusion Criteria:

- A histopathological or cytological diagnosis of non-resectable, recurrent or
metastatic biliary tract (intra- or extra-hepatic), gallbladder or ampullary
carcinoma

- ECOG performance status 0, 1, or 2

- Age ≥ 18

- Estimated life expectancy > 3 months

- Adequate haematological function:

- Haemoglobin * 10g/dL (prior transfusions for patients with low haemoglobin are
allowed)

- WBC >/= 3.0 x 10*9/L

- Absolute neutrophil count (ANC) >/= 1.5 x 10*9/L

- Platelet count >/= 100,000/mm*3)

- Adequate liver function:

- Total bilirubin ≤1.5 x upper limit of normal (ULN) OR ≤ 3.0 x upper limit of normal
(ULN) if stable for a duration of two weeks • ALT and/or AST & alkaline
phosphatase ≤ 5 x ULN

- Adequate renal function:

- Serum urea and serum creatinine < 1.5 times ULN

- Calculated GFR >/= 45 mL/min. If the calculated GFR is below 60, isotope EDTA
confirmation of adequate renal function is required

- No evidence of active uncontrolled infection (patients on antibiotics are eligible)

- Capable of giving written informed consent

Exclusion Criteria:

- Incomplete recovery from previous surgery.

- Patients undergoing current treatment with curative intent.

- History of prior malignancy that could interfere with the response evaluation
(exceptions include in-situ carcinoma of the cervix treated by cone-biopsy/resection,
non-metastatic basal and/or squamous cell carcinomas of the skin, any early stage
(stage I) malignancy adequately resected for cure greater than 5 years previously).

- Any evidence of severe or uncontrolled systemic diseases or laboratory finding that
in the view of the investigator makes it undesirable for the patient to participate
in the trial.

- Any psychiatric or other disorder (eg brain metastases) likely to impact on informed
consent.

- Pregnancy or breast-feeding. •Women of child-bearing potential should must have a
negative pregnancy test prior to study entry AND be using an adequate contraception
method, which must be continued for 3 months after completion of chemotherapy

- NB. Whilst not excluded, patients with significant impaired hearing must be made
aware of potential ototoxicity and may choose not to be included. If included,
baseline audiograms are recommended and, in those randomised to cisplatin, should be
followed by repeat audiograms prior to cycle 2.

- Patients with any grade NYHA cardiomyopathy and uncontrolled hypertension
(>150/95mmhg).