COCOON: Discussion of Clinical End Points and Dose Modifications

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

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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

EP: 9.Operational Considerations: Workflow Adjustments and Monitoring Systems for Effective COCOON Implementation

EP: 10.COCOON in Practice: Patient Preparation, Key Insights, and Implementation Best Practices

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Dermatologic Adverse Events—COCOON vs Standard of Care

Study Focus:
This study assessed the impact of the COCOON dermatologic management intervention vs standard of care in reducing dermatologic adverse events (DAEs) during oncology treatment.

Primary End Point:

• Grade 2 or higher dermatologic adverse events within the first 12 weeks

Key Findings:

• Grade 2 or higher DAEs:
• COCOON: 38%
• Standard of care: 76%

• Half the rate of significant skin toxicities with COCOON
• Grade 3 DAEs:
• COCOON: 4.3%

• Standard of care: 8.8%

• Severe cases were also notably reduced.
• Statistical significance:
• OR: 0.19—a highly significant finding, rarely seen in oncology

DAEs by Location:

• Face/body: 23% (COCOON) vs 62% (standard of care)
• Scalp: 9% vs 29%—noted as particularly difficult to manage because of the risk of infection and scabbing
• Paronychia: 16% vs 21%—bothersome, especially in dry weather, but generally manageable

Clinical Impact:

• The COCOON intervention not only reduced the severity and frequency of DAEs but also helped patients:
• Stay on treatment longer

• Avoid dose interruptions and reductions

Treatment Tolerability:

• Dose interruptions: 16% (COCOON) vs 34% (standard of care)
• Dose reductions: 7% (COCOON) vs 19% (standard of care)
• Discontinuations: 1 patient (COCOON) vs 3 patients (standard of care)

Conclusion:
The COCOON intervention significantly reduces dermatologic toxicities, improves patient quality of life, and allows for better adherence to cancer therapy within the critical first 12 weeks, and likely beyond.