Prophylaxis Regimens and Setting Expectations Before Cycle 1

Amanda Edmond, PA-C, of Banner MD Anderson Cancer Center at Banner Gateway Medical Center, reviews the venous thromboembolism (VTE) data behind the COCOON prophylaxis approach in EGFR-mutated non-small cell lung cancer. In MARIPOSA, where no prophylaxis was given, about 37% of patients developed VTE. Placing patients on an anticoagulant for the first 4 months brings that rate back toward the roughly 10% to 11% baseline risk carried by patients with lung cancer. Edmond also uses the adverse reaction timeline in her first conversation with patients, explaining that most reactions with amivantamab plus lazertinib appear early and taper substantially after 4 months, which she describes as a light at the end of the tunnel that helps patients stay on treatment longer. She frames the upfront work as empowering rather than burdensome, noting that patients with EGFR mutations tend to be younger and are often still working.