Managing Dermatologic AEs With Amivantamab/Lazertinib: Updates From the COCOON Clinical Trial
Panelists discuss how the COCOON study’s advanced dermatologic prophylaxis protocol, including systemic antibiotics and topical treatments, can reduce skin toxicities by 50% in patients receiving amivantamab plus lazertinib therapy.
The COCOON clinical trial has provided crucial insights into proactive dermatologic adverse event management for patients receiving amivantamab plus lazertinib combination therapy. This study specifically evaluated treatment-naive patients on the MARIPOSA regimen with and without advanced dermatological support protocols, comparing enhanced prophylactic measures against standard dermatologic care. The advanced dermatology support regimen includes systematic antibiotic prophylaxis with doxycycline or minocycline (doxycycline 100 mg for the first 3 months), topical clindamycin gel for scalp application, 4% chlorhexidine for nail care, and ceramide-based moisturizers for comprehensive skin protection.
Results from the COCOON study demonstrated a significant 2-fold reduction in skin toxicities when advanced dermatologic prophylaxis was implemented compared with standard care approaches. This evidence validates the effectiveness of proactive management strategies and supports the routine implementation of enhanced dermatologic protocols for patients receiving amivantamab-based therapy. The study’s findings have practical implications for clinical practice, providing evidence-based justification for comprehensive prophylactic regimens that may initially seem resource intensive but ultimately improve patient outcomes and treatment tolerability.
Implementation of COCOON-based protocols in clinical practice has shown consistent benefits, with practitioners reporting improved patient experiences and reduced severity of dermatologic adverse events. The comprehensive approach includes patient education about sun protection, proper use of prophylactic antibiotics with consideration for gastrointestinal tolerance, frequent skin moisturizing with ceramide-based products, and early intervention with topical steroids when indicated. Collaboration with dermatology specialists, either within the institution or through community partnerships, provides additional expertise for complex cases that require specialized intervention beyond the oncology team’s scope of practice.
