Enhanced Prophylactic Regimen Reduces Skin AEs With Amivantamab-Lazertinib: Byoung Chul Cho, MD, PhD

An enhanced dermatologic management (DM) strategy, COCOON DM, significantly reduced the incidence and severity of dermatologic adverse events (AEs) among patients receiving amivantamab plus lazertinib for EGFR-mutant advanced non–small cell lung cancer (NSCLC), according to data presented at the 2025 World Conference on Lung Cancer.

The new findings from the fully enrolled population of the phase 2 COCOON trial (NCT06120140) reinforce the efficacy of COCOON DM to mitigate AEs associated with amivantamab plus lazertinib.

"This supportive care strategy enhances the benefit-risk ratio of amivantamab plus lazertinib in the first-line setting, supporting the role of this regimen as a new standard of care in treatment-naïve, EGFR-mutant, advanced NSCLC," study author Byoung Chul Cho, MD, PhD, professor of internal medicine in the Division of Medical Oncology at the Yonsei Cancer Center, Yonsei University College of Medicine, said in an interview with The American Journal of Managed Care^®.

The study randomized 199 patients with previously untreated, EGFR-mutant, locally advanced or metastatic NSCLC to receive either COCOON DM (n = 99) or standard-of-care DM (n = 100) alongside amivantamab plus lazertinib. At week 12, COCOON DM demonstrated significant benefits vs standard-of-care DM, with 26% of patients experiencing face or body dermatologic AEs other than paronychia with the enhanced regimen compared with 59% receiving standard DM (P < .0001). In the COCOON DM arm, 10% of patients experienced scalp dermatologic AEs vs 26% in the standard DM arm (P = .005).

The COCOON DM regimen includes a combination of oral and topical treatments: oral doxycycline or minocycline at a 100-mg dose twice daily for 12 weeks, chlorhexidine 4% on fingernails and toenails daily for 12 months, clindamycin 1% lotion on the scalp daily from weeks 13 to 52, and ceramide-based moisturizer for the face and body for 12 months. Importantly, the regimen is easy to use and widely available, which is especially important for patients receiving treatment outside of academic cancer centers, Cho explained.

“COCOON DM is designed for the majority of non–small cell lung cancer patients, who are not seen in academic centers,” he said. “I think this regimen is really feasible, because this is a simple regimen, straightforward, inexpensive, and nurse-driven.”

Reference

Cho BC, Li W, Spira AI, et al. Enhanced vs standard dermatologic management with amivantamab-lazertinib in EGFRm advanced NSCLC: the COCOON global RCT. Presented at: 2025 World Conference on Lung Cancer; September 6-9, 2025; Barcelona, Spain. Abstract P3.12.46