A Phase 2 Study of Efatutazone, an Oral PPAR Agonist, In Combination With Paclitaxel in Patients With Advanced Anaplastic Thyroid Cancer

‣ Patients must have histologically or cytologically diagnosed advanced anaplastic thyroid cancer (ATC)

‣ Patients must have measurable disease

‣ Patients must have either metastatic (stage IVC) or locally advanced unresectable disease (stage IVB)

‣ Patients should have resolution of any toxic effects of prior therapy (except alopecia) to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, grade 1

‣ There is no limit to the number of prior lines of treatment a patient has received

‣ No treatment with chemotherapy, radiation therapy, immunotherapy, biological therapy, hormonal therapy, or other thiazolidinediones (TZDs) =\< 21 days before study registration

‣ No prior taxane therapy =\< 6 months, except as a radiosensitizer

‣ No history of the following:

⁃ Class III or IV congestive heart failure (CHF)

• Grade 3 or 4 thromboembolic event =\< 6 months

• Pericardial effusion =\< 12 months (any grade)

• Pericardial involvement with tumor

• Grade 2 or higher pleural effusion =\< 6 months

‣ No current symptomatic, untreated, or uncontrolled brain metastases present

‣ No major surgery =\< 14 days prior to registration

‣ No grade 2 or higher neuropathy

‣ No known history of severe hypersensitivity reactions to any of the components of efatutazone or paclitaxel formulations

‣ Not pregnant and not nursing; women of childbearing potential only, a negative pregnancy test done =\< 7 days prior to registration is required

‣ Patients with diabetes mellitus requiring concurrent treatment with insulin or thiazolidinedione (TZD) oral agents are not eligible

‣ Patients with known hypersensitivity to any TZD oral agents are not eligible

‣ Eastern Cooperative Oncology Group (ECOG) performance status =\< 2

‣ Absolute neutrophil count (ANC) \>= 1,500/mm\^3

‣ Platelet count \>= 100,000/mm\^3

‣ Creatinine =\< 1.5 x upper limit of normal (ULN) mg/dL OR calculated (calc.) creatinine clearance \>= 60 mL/min

‣ Bilirubin =\< 1.5 x ULN

‣ Aspartate aminotransferase (AST) =\< 2.5 x ULN