Dermatologic adverse events in the treatment of NSCLC with amivantamab plus lazertinib significantly reduced
Prof Nicolas Girard - Institut Curie, Paris, France
The first study is the COCOON trial which assessed whether prophylactic dermatologic management could prevent the incidence of dermatologic adverse events related to amivantamab plus lazertinib. Amivantamab plus lazertinib is a new standard of care for patients with EGFR-mutated non-small cell lung cancer in the first-line setting based on the MARIPOSA trial. During ELCC the final overall survival analysis of the MARIPOSA trial was presented and amivantamab plus lazertinib significantly prolongs the overall survival versus the historic standard of care which was osimertinib.
The issue with amivantamab plus lazertinib is that it increases the risk of adverse events, especially dermatological adverse events. So this is why we built the COCOON trial that compares prophylactic dermatologic management versus standard of care in combination with amivantamab plus lazertinib for the first-line treatment of patients with EGFR-mutated non-small cell lung cancer.
The COCOON regimen includes doxycycline, oral doxycycline, topical clindamycin on the scalp, ceramide-based moisturiser on the body and face, and chlorohexidine on the nails. The standard of care usually consists of dermatologic management, which is often reactive, with antibiotics and steroids.
In the COCOON trial 138 patients were enrolled. We had the first and interim analysis showed that the COCOON regimen significantly reduces by 50% the incidence of grade 2 or higher dermatologic adverse events in combination with amivantamab plus lazertinib from 77% to 39% which is highly significant. So amivantamab plus lazertinib is a new standard of care for the treatment of patients with EGFR-mutated non-small cell lung cancer. With overall survival data we expect more patients to receive this combination and the COCOON prophylactic dermatologic management clearly helps to improve the patient experience, together with other easy to use and widely available measures, to prevent VTE with prophylactic anticoagulation and infusion-related reactions with dexamethasone.
What do you think is the clinical significance of these results?
The clinical significance of the COCOON data is very important. The COCOON regimen should readily be implemented in clinical practice for the treatment of patients receiving amivantamab plus lazertinib.
