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

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

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

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

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COCOON Protocol and Proactive Management of Amivantamab and Lazertinib Therapy

Overview: During this discussion, the physicians emphasized the importance of structured patient and caregiver education prior to initiating the COCOON protocol, specifically in the context of amivantamaband lazertinib therapy. The conversation highlighted the proactive management of anticipated adverse effects and the need for comprehensive support to optimize patient outcomes.

Key Takeaways:

Patient and Caregiver Education Resources:

A worksheet or preparatory guide is recommended to inform patients about the medications involved, potential adverse effects, and management strategies.

Patients are encouraged to independently research the COCOON protocol, including reviewing webinars to better understand expected benefits and rationale for proactive care.

Importance of Proactive Adverse Effect Management:

Common adverse effects of amivantamaband lazertinib include:

Nail changes

Scalp issues

Skin rashes

These effects are predictable and manageable when addressed early.

Physicians and advanced practice providers (APPs) should initiate patient engagement prior to day 1 of treatment.

Pretreatment Checklist: Patients should be equipped with:

Chlorhexidine wash to maintain skin hygiene

Doxycycline prescription for its anti-inflammatory and antibacterial properties

Ceramide-containing moisturizers to support the skin barrier

Clindamycin topical lotion, specifically for scalp application

Clinical Practice Shift, From Reactive to Proactive:

Historically, management of EGFR inhibitor–related adverse effects has been reactive.

The COCOON approach demonstrates that proactive strategies significantly improve outcomes, setting a new standard for managing other high-risk therapies.

This methodology is influencing a broader shift in how providers approach rash-prone and adverse effect–prone cancer therapies.

Interdisciplinary Team Collaboration:

There is a strong emphasis on teamwork between physicians and APPs in managing both cancer treatment and adverse effect mitigation.

Ongoing education and consistent messaging among care teams are essential for implementation success.

Conclusion: The COCOON approach represents a paradigm shift in oncologic supportive care—proactive adverse effect management is no longer optional, but essential. By preparing patients and caregivers with resources, guidance, and early interventions, we not only enhance adherence but potentially improve therapeutic efficacy and quality of life. Continued collaboration, education, and communication across teams are paramount to sustaining this model.