Overview of Study Design of the COCOON Trial

EP: 1.Clinical Insights: Experiences With Amivantamab-Lazertinib in EGFR-Mutant NSCLC

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EP: 2.Overview of Study Design of the COCOON Trial

EP: 3.COCOON Baseline Characteristics

EP: 4.COCOON: Discussion of Clinical End Points and Dose Modifications

EP: 5.Initial Reactions to COCOON Study’s Dermatologic/Nail AE Reductions

EP: 6.Clinician Experiences: COCOON Regimen vs Traditional SoC AE Management

EP: 7.Measuring Impact: Observed Differences in Dermatologic AEs Between COCOON Protocol and Standard Approaches

EP: 8.Building Support Systems: Resources and Multidisciplinary Collaboration for Optimizing COCOON Implementation

EP: 9.Operational Considerations: Workflow Adjustments and Monitoring Systems for Effective COCOON Implementation

EP: 10.COCOON in Practice: Patient Preparation, Key Insights, and Implementation Best Practices

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MARIPOSA Regimen and Dermatologic Management

The MARIPOSA regimen, which incorporates amivantamab plus lazertinib, has demonstrated a notable survival benefit, with a median overall survival not yet reached in the treatment arm—an impressive indicator, especially when a 1-year survival advantage is already evident.

A subanalysis focused on dermatologic toxicity evaluated enhanced dermatologic management vs standard of care in patients receiving this regimen. The study included 99 patients in the experimental arm and 102 in the control arm, with the primary end point being the incidence of 2 or more adverse events within the first 12 weeks—a critical period when most dermatologic adverse effects emerge.

Enhanced dermatologic management (prophylactic approach) included:

• Oral doxycycline or minocycline for 12 weeks
• Topical clindamycin on the scalp
• Chlorhexidine for nail care
• Ceramide-based moisturizer for body and face

Standard of care allowed for physician discretion, often involving general skin prophylaxis, topical/systemic antibiotics, and steroids.

In both arms, venous thromboembolic event prophylaxis was mandated for the first 4 months using anticoagulation of choice.

Clinical Insights:

• Patients showed strong adherence with the proactive regimen, attributed to ease of access and affordability of medications (many available over the counter or online).
• Most dermatologic adverse events occurred within the first 4 months, emphasizing the importance of early and consistent prophylactic management.
• Proactive management may improve treatment adherence and patient outcomes, reinforcing the value of structured supportive care protocols in regimens with known cutaneous toxicity profiles.