Building Support Systems: Resources and Multidisciplinary Collaboration for Optimizing COCOON Implementation
Panelists discuss how keeping management of dermatologic adverse effects “in-house” with oncology teams is often preferable to referring patients to dermatologists, though some patients occasionally benefit from specialized care for nail issues.
EP: 1.Clinical Insights: Experiences With Amivantamab-Lazertinib in EGFR-Mutant NSCLC
EP: 2.Overview of Study Design of the COCOON Trial
EP: 3.COCOON Baseline Characteristics
EP: 4.COCOON: Discussion of Clinical End Points and Dose Modifications
EP: 5.Initial Reactions to COCOON Study’s Dermatologic/Nail AE Reductions
EP: 6.Clinician Experiences: COCOON Regimen vs Traditional SoC AE Management
EP: 7.Measuring Impact: Observed Differences in Dermatologic AEs Between COCOON Protocol and Standard Approaches
EP: 8.Building Support Systems: Resources and Multidisciplinary Collaboration for Optimizing COCOON Implementation
Video content above is prompted by the following:
Multidisciplinary Approach to Amivantamab-Related Dermatologic Adverse Effects
Current Management Approach
The discussion highlights a preference for managing amivantamab-related dermatologic adverse effects “in-house” rather than routinely referring to dermatology for several practical reasons:
Limited dermatology appointment availability (typical 2-month wait times)
Patient burden considerations (multiple appointments, additional co-pays)
Better continuity of care when treated by the primary oncology team
Recognition that these adverse effects are treatment-related and predictable
Additional Support Resources
Several supportive care measures were identified:
- Some patients independently sought specialized care:
- Podiatry consultation for toenail issues, including curettage for granuloma tissue
- Occasional dermatology referrals that sometimes-yielded novel management strategies
- Suggested workflow improvements:
- Prebuilt order sets for prophylactic oral and topical antibiotics
- Standardized patient education materials (1-page handout or brochure)
- Comprehensive supportive care toolkit outlining:
- Adverse effects to monitor
- Recommended preventive regimens
- Management strategies
- Existing resources:
- Electronic medical record may already contain standardized order sets
Recommendations for Practice Enhancement
The summary suggests a COCOON regimen approach that appears to be a standardized protocol for managing amivantamab-related dermatologic toxicities, with emphasis on streamlining implementation through:
- Systematic prophylactic measures
- Patient education and anticipatory guidance
- Reducing administrative burden through standardized ordering processes
This approach balances comprehensive toxicity management while minimizing additional appointments and maintaining continuity within the oncology care team.
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