What palliative, systemic treatment would you consider for a patient with an extensive Klatskin tumor with associated hyperbilirubinemia (bilirubin >20) not amenable to local intervention?

Localized Klatskin (hilar) cholangiocarcinomas defined as disease without nodal or metastatic spread and less than 3cm in size radially above the cystic duct are potential transplant candidates with the Mayo Clinic Protocol (Zamora-Valdes and Heimbach. PMID 29735023).

For disease not meeting the abov...

Folfox.