COCOON Regimen Eases Amivantamab/Lazertinib Derm Toxicities in NSCLC

Early insights from the phase 2 COCOON trial (NCT06120140) suggest that frontline use of amivantamab (Rybrevant) and lazertinib (Leclaza) may help oncology teams better anticipate and manage treatment-related toxicities in patients with EGFR-mutant advanced or metastatic non–small cell lung cancer (NSCLC), explained Jillian Thompson, MSN, ANP-BC, AOCNP.

In an interview with Oncology Nursing News after moderating a Case-Based Roundtable on frontline treatments in EGFR-mutated NSCLC, Thompson noted that her clinical experience reflects a clear contrast between earlier practice patterns without COCOON guidance and the more proactive strategies now informed by these emerging data.

Prior to COCOON data, Thompson had a patient whose dermatologic toxicities became severe. Without COCOON-informed protocols available at the time, her team used multiple supportive measures including dermatology referral. After resuming treatment with amivantamab at a reduced dose and applying COCOON-based approaches, the patient is tolerating therapy more successfully.

Thompson explained that patients treated from the outset with COCOON-guided management have shown markedly improved tolerability compared with early trial participants. She emphasized that seeing both the most challenging cases and the well-managed outcomes provides her with greater confidence in using these agents in the frontline setting.

Transcript

I’ve had experience with amivantamab and lazertinib on clinical trial. I had a patient that had terrible skin toxicity, and that alarmed me. COCOON was not out yet. We did everything that we thought we could do. We sent her to a dermatologist, but there are a lot of dermatologists that are not versed on that. It was very severe, so it required us to hold the treatment for quite some time. We have since resumed this patient on the amivantamab. She’s on that single agent, but we’re using COCOON. We did do a dose reduction, and she’s tolerating things much better.

Surprisingly, with clinical trial, I have a good number of a couple of patients on the clinical trial who are doing amazingly well. Now, from the very beginning, we’re using cocoon. I was expecting these trial patients to have horrible symptoms, and then to be able to see what it was like using COCOON data from the very beginning, the results were worlds apart. I’ve seen the very, very worst, and now I’m seeing well-managed toxicities, so I feel much more comfortable with it now.

This transcript has been edited for clarity and conciseness.