Insights from COCOON: Prophylactic Dermatologic Management With Amivantamab + Lazertinib in Advanced NSCLC
A panelist discusses how the COCOON study demonstrated that enhanced dermatologic management significantly reduces the incidence and severity of dermatologic adverse events (DAEs) in patients with locally advanced or metastatic EGFR-mutated non–small cell lung cancer (NSCLC) receiving first-line treatment with amivantamab and lazertinib, improving both quality of life and treatment adherence.
Summary for Physicians: 1L Therapies for LA/M EGFR-Mutated NSCLC
Summary for Physicians: COCOON Study Findings Presented at European Lung Cancer Congress 2025
The COCOON study is a Phase 2, open-label, randomized clinical trial designed to evaluate the impact of enhanced dermatologic management on DAEs in patients with locally advanced or metastatic (LA/M) EGFR-mutated NSCLC receiving first-line treatment with amivantamab and lazertinib. The study specifically addresses the unmet need for effective management of skin-related toxicities associated with EGFR-targeted therapies, which can significantly affect patients' quality of life and treatment adherence.
Study Arms and Regimens:
- Enhanced dermatologic management arm:
- Patients receive a proactive regimen comprising prophylactic antibiotics, comprehensive skin moisturization, and strategies to prevent paronychia (nail inflammation). This approach aims to minimize the occurrence and severity of DAEs during treatment.
- Standard dermatologic management arm:
- Patients receive conventional care, which may include reactive treatments initiated after the onset of dermatologic toxicities.
Primary End Point:
- Incidence of Grade 2 DAEs:
- The primary objective was to assess the incidence of Grade 2 DAEs within the first 12 weeks of treatment. The enhanced management strategy demonstrated a statistically significant and clinically meaningful reduction in the occurrence of these adverse events compared with standard care.
Secondary End Points:
- Severity and frequency of dermatologic toxicities:
- Enhanced management resulted in a lower severity and frequency of DAEs, contributing to improved patient comfort and potentially better treatment adherence.
- Quality-of-life assessments:
- Patients in the enhanced management arm reported improved quality-of-life metrics, likely due to reduced DAEs.
- Treatment compliance:
- The proactive dermatologic care approach was associated with higher treatment adherence rates, as patients experienced fewer treatment interruptions related to skin toxicities.
Addressing Unmet Needs in Clinical Practice:
The COCOON study directly addresses a significant unmet need by providing evidence-based strategies to manage dermatologic toxicities associated with EGFR-targeted therapies. By implementing enhanced dermatologic care, health care providers can offer patients a more tolerable treatment experience, potentially leading to:
- Improved patient quality of life: Effective management of skin-related adverse effects enhances daily functioning and emotional well-being.
- Increased treatment adherence: Minimizing AEs supports consistent therapy continuation, which may improve clinical outcomes.
- Optimized clinical outcomes: Addressing dermatologic toxicities proactively may reduce the need for dose modifications or interruptions, ensuring patients receive the full benefit of their prescribed therapy.
Incorporating enhanced dermatologic management into routine care for patients undergoing treatment with amivantamab and lazertinib represents a meaningful advancement in supportive oncology care, aligning with the goal of personalized medicine that considers both the efficacy and tolerability of cancer therapies.
