Enhanced vs Standard Dermatologic Management With Amivantamab-Lazertinib in EGFRm Advanced NSCLC: The COCOON Global RCT

Panelists discuss how patients with EGFR-mutated non–small cell lung cancer develop dermatologic adverse events with amivantamab treatment, presenting as papules, pustules, and paronychia that significantly impact quality of life.

Panelists discuss how dermatologic adverse events with EGFR inhibitors are more severe than previously seen with third-generation tyrosine kinase inhibitors, requiring reactive management strategies including topical steroids, antibiotics, and dermatologic consultations that are often difficult to obtain.

Panelists discuss how the COCOON study randomly assigned patients to either standard care or proactive dermatologic management using prophylactic antibiotics, topical treatments, skin moisturization, and anticoagulation to reduce grade 2 or higher dermatologic adverse events.

Panelists discuss how the COCOON trial design represents a straightforward approach using standard practice medications, though implementation challenges include patient compliance with the complex 4-drug regimen requiring significant education and support staff involvement.

Panelists discuss how the COCOON study demonstrated a significant reduction in grade 2 or higher dermatologic adverse events from 73% to 41%, with particularly notable improvements in face, body, and scalp rashes while maintaining comparable response rates.

Panelists discuss how the COCOON regimen's tolerability and effectiveness in reducing dose interruptions will improve patient experience and outcomes, requiring substantial nursing support and patient education for successful implementation in clinical practice.

Panelists discuss how the field is shifting from reactive to proactive management of dermatologic adverse events, with future developments potentially including new topical treatments and integrated dermatology support within oncology practices.