Preventing Moderate to Severe Dermatologic Adverse Events in First-Line EGFR-Mutant Advanced NSCLC Treated With Amivantamab Plus Lazertinib: Early Success of the COCOON Trial

Panelists discuss how amivantamab plus lazertinib therapy for EGFR-mutant non–small cell lung cancer has shown promising survival data while highlighting the importance of managing adverse events for improved quality of life.

Panelists discuss how the COCOON trial demonstrated that enhanced dermatologic management significantly reduced grade 2 or higher skin-related adverse events (38% vs 76%) compared with standard of care for patients receiving amivantamab plus lazertinib.

Panelists discuss how the baseline characteristics of patients in the COCOON trial were evenly matched, with slightly more women than men and a significant number of Asian patients, which is typical for EGFR-mutant non–small cell lung cancer.

Panelists discuss how the COCOON dermatologic management protocol significantly reduced grade 2 or higher dermatologic adverse events in multiple locations, particularly on the face/body (23% vs 62%), scalp (9% vs 29%), and nails (16% vs 21%).

Panelists discuss how patients have been receptive to the proactive management approach that effectively reduces dermatologic adverse effects, despite initial concerns about adding multiple prophylactic interventions.

Panelists discuss how the standardized COCOON regimen offers clear guidance for managing dermatologic adverse effects, with specific components such as clindamycin lotion for the scalp and chlorhexidine wash for nails showing effectiveness.

Panelists discuss how regular monitoring, patient education about reporting symptoms promptly, and visual assessment during biweekly visits are essential for effectively managing dermatologic adverse events.

Panelists discuss how keeping management of dermatologic adverse effects “in-house” with oncology teams is often preferable to referring patients to dermatologists, though some patients occasionally benefit from specialized care for nail issues.

Panelists discuss how implementing standardized order sets in electronic medical records and providing printed patient education materials can help streamline the COCOON protocol implementation.

Panelists discuss how proactive management of adverse effects through the COCOON protocol represents a paradigm shift that could be applied to other EGFR inhibitors, emphasizing early intervention before symptoms appear.