Enhanced Dermatological Care to Reduce Rash and Paronychia in Epidermal Growth Factor Receptor (EGRF)-Mutated Non-Small Cell Lung Cancer (NSCLC) Treated First-line With Amivantamab Plus Lazertinib
COCOON
A Phase 2, Open-Label, Randomized Trial Evaluating the Impact of Enhanced Versus Standard Dermatologic Management on Selected Dermatologic Adverse Events Among Patients With Locally Advanced or Metastatic EGFR-Mutated NSCLC Treated First-Line With Amivantamab + Lazertinib
2 other identifiers
interventional
305
11 countries
93
Brief Summary
The purpose of this study is to evaluate whether enhanced dermatologic management can reduce incidence of grade greater than or equal to (\>=) 2 dermatologic adverse events of interest (DAEIs) when compared with standard-of-care skin management and with modified enhanced dermatologic management in participants with locally advanced or metastatic stage IIIB/C-IV epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) treated first-line with amivantamab and lazertinib. The study also includes Expansion cohorts (in 2 different schedules) to evaluate enhanced dermatologic management and early intervention for DAEIs or paronychia, in participants receiving subcutaneous amivantamab and lazertinib. A substudy will enroll participants from Arms A and B who experience specific new-onset or persistent DAEIs (Grade \>=2) during treatment with intravenous (IV) amivantamab and lazertinib. This substudy aims to assess the reactive use of dermatologic treatment strategies in these participants.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for phase_2
Started Feb 2024
Longer than P75 for phase_2
93 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
November 2, 2023
CompletedFirst Posted
Study publicly available on registry
November 7, 2023
CompletedStudy Start
First participant enrolled
February 16, 2024
CompletedPrimary Completion
Last participant's last visit for primary outcome
May 31, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
January 31, 2032
June 5, 2026
June 1, 2026
3.3 years
November 2, 2023
June 4, 2026
Conditions
Outcome Measures
Primary Outcomes (1)
Number of Participants With Grade Greater Than or Equal to (>=) 2 Dermatologic Adverse Events of Interest (DAEIs) Within 12 Weeks After Initiation of Anticancer Treatment
Number of participants with Grade \>= 2 DAEIs within 12 weeks after initiation of anticancer treatment based on National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI-CTCAE) Version (v) 5.0 will be reported. DAEIs includes rash, dermatitis acneiform, pruritus, skin fissures, acne, folliculitis, erythema, eczema, rash maculo-papular, skin exfoliation, skin lesion, skin irritation, dermatitis, rash erythematous, rash macular, rash popular, rash pruritic, rash pustular, dermatitis contact, dermatitis exfoliative generalized, drug eruption, dyshidrotic eczema, eczema asteatotic and paronychia. As per NCI CTCAE v 5.0, severity scale ranges from Grade 1 (mild) to Grade 5 (death). Grade 1= mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening, and Grade 5= death related to adverse event.
Up to 12 weeks after initiation of anticancer treatment
Secondary Outcomes (21)
Number of Participants With DAEIs by Severity Based on NCI-CTCAE v 5.0
Up to 12 weeks after initiation of anticancer treatment
Number of Participants With Grade >=2 DAEIs Within 6 Months After Initiation of Anticancer Treatment Based on NCI-CTCAE v 5.0
Up to 6 months after initiation of anticancer treatment
Number of Grade >= 2 DAEI Per Participants
Up to 12 months
Time to First Occurrence of Grade >=2 DAEI
Up to 12 months
Time to Resolution of Grade >= 2 DAEI
Up to 12 months
- +16 more secondary outcomes
Other Outcomes (1)
Percentage of Participants Achieving Best Response for the Dermatologic Adverse Event
Up to 12 weeks
Study Arms (6)
Arm A: Enhanced Dermatologic Management
EXPERIMENTALParticipants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule, clindamycin topical lotion, chlorhexidine topical solution, and noncomedogenic skin moisturizer during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab intravenously (Dose 1 for body weight \[BW\] less than 80 kilograms \[kg\] and Dose 2 for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\]) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm B: Standard-of-Care Dermatologic Management
ACTIVE COMPARATORParticipants will receive standard care for dermatologic management according to local practice to reduce dermatologic toxicities in skin and nail during background anticancer treatment of advanced or metastatic EGFR-mutated NSCLC with amivantamab administered as IV infusion plus lazertinib, dose and dosing schedule as same as experimental arm.
Sub-study: Cohort A: Ruxolitinib
EXPERIMENTALParticipants enrolled in Arms A and B of the main study who experience new-onset or persistent specific DAEIs (Grade greater than or equal to \[\>=\] 2, as defined by National Cancer Institute Common Terminology Criteria for Adverse Events \[NCI-CTCAE\] v5.0) will be enrolled and receive reactive treatment with ruxolitinib in the sub-study. Participants in the sub-study will continue to receive amivantamab and lazertinib.
Sub-study: Cohort B: Tacrolimus
EXPERIMENTALParticipants enrolled in Arms A and B of the main study who experience new-onset or persistent specific DAEIs (Grade \>= 2, as defined by NCI-CTCAE v5.0) will be enrolled and receive reactive treatment with tacrolimus in the sub-study. Participants in the sub-study will continue to receive amivantamab and lazertinib.
Amivantamab Subcutaneous (SC) Expansion Cohort: Standard Schedule
EXPERIMENTALParticipants will receive modified enhanced dermatologic management with oral doxycycline or minocycline, zinc gluconate and noncomedogenic skin moisturizer during background anticancer treatment of advanced or metastatic EGFR mutated NSCLC with amivantamab SC and lazertinib as per standard schedule. If a participant develops a dermatologic adverse event of interest (DAEI) they will receive early intervention as follows: for facial (ruxolitinib), for scalp (oral propranolol and clobetasol), for paronychia (chlorhexidine in addition to timolol) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1.
Amivantamab SC Expansion Cohort: Modified Schedule
EXPERIMENTALParticipants will receive modified enhanced dermatologic management with oral doxycycline or minocycline, zinc gluconate and noncomedogenic skin moisturizer during background anticancer treatment of advanced or metastatic EGFR mutated NSCLC with amivantamab SC and lazertinib as per modified schedule. If a participant develops a DAEI they will receive early intervention as follows: for facial (ruxolitinib), for scalp (oral propranolol and clobetasol), for paronychia (chlorhexidine in addition to timolol) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1.
Interventions
Amivantamab will be administered.
Amivantamab will be administered as SC injection.
Lazertinib tablet will be administered orally.
Doxycycline tablet will be administered orally.
Zinc gluconate tablet will be administered.
Propranolol tablet will be administered.
Timolol will be used to the affected skin area.
Clobetasol shampoo will be used on the scalp.
Minocycline capsule will be administered orally.
Clindamycin lotion will be used as topical application on the scalp.
Chlorhexidine solution will be used as topical application on hands and feet.
Noncomedogenic skin moisturizer will be used as topical application.
Ruxolitinib will be used to the affected skin area.
Tacrolimus will be used as topical application to the affected skin area.
Eligibility Criteria
You may qualify if:
- Have histologically or cytologically confirmed, locally advanced or metastatic non-small cell lung cancer (NSCLC); Is treatment naive and not amenable to curative therapy including surgical resection or (chemo) radiation. Adjuvant or neoadjuvant therapy for Stage I, Stage II or Stage IIIA disease is allowed if last dose administered more than 12 months prior to the development of locally advanced or metastatic disease
- Have a tumor that harbors an epidermal growth factor receptor (EGFR) Exon 19del or Exon 21 L858R substitution, as detected by an Food and Drug Administration (FDA)-approved or other validated test in a clinical laboratory improvement amendments (CLIA)-certified laboratory (sites in the United States) or an accredited local laboratory (sites outside of the United States) in accordance with site standard-of-care
- A participant with asymptomatic or previously treated and stable brain metastases may participate in this study. Participants with a history of symptomatic brain metastases must have had all lesions treated as clinically indicated (that is, no current indication for further definitive local therapy). Any definitive local therapy to brain metastases must have been completed at least 14 days prior to randomization, and the participant can be receiving no greater than 10 milligram (mg) prednisone or equivalent daily for the treatment of intracranial disease
- Can have prior or concurrent second malignancy (other than the disease under study) which natural history or treatment is unlikely to interfere with any study endpoints, safety, or the efficacy of the study treatment(s). For the amivantamab SC expansion cohorts: Due to the increased risk of skin cancer with ruxolitinib, participants with any prior or concurrent skin malignancies will be excluded
- Sub-study: Participants must have new-onset or persistent (defined as non-responsive to standard of care \[SoC\]) Grade \>=2 specific DAEIs of the scalp, face, or body, as defined by NCI-CTCAE Grading v5.0 for DAEIs (excluding paronychia)
You may not qualify if:
- History of uncontrolled illness, including but not limited to uncontrolled diabetes; ongoing or active infection (includes infection requiring treatment with antimicrobial therapy \[participants will be required to complete antibiotics 1 week prior to starting background anticancer treatment\] or diagnosed or suspected viral infection). For the amivantamab SC expansion cohorts, this includes active localized serious infections; active bleeding diathesis; impaired oxygenation requiring continuous oxygen supplementation; refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption of background anticancer treatment or doxycycline/minocycline; psychiatric illness, social situation, or any other circumstances that would limit compliance with study requirements; any ophthalmologic condition that is clinically unstable; pre-existing skin condition that would prevent adequate evaluations of dermatologic toxicity, as determined by the investigator
- Medical history of interstitial lung disease (ILD), including drug-induced ILD or radiation pneumonitis
- Known allergy, hypersensitivity, or intolerance to the excipients of amivantamab, lazertinib, or to tetracyclines, doxycycline, minocycline, timolol\*, ruxolitinib\*, zinc\*, corticosteroids\* or their excipients or to any component of the enhanced dermatologic management (\*for the amivantamab SC expansion cohorts)
- Participant has received any prior systemic treatment at any time for locally advanced stage III B/C or metastatic stage IV disease (adjuvant or neoadjuvant therapy for stage I, II or IIIA disease is allowed if last dose administered more than 12 months prior to the development of locally advanced or metastatic disease)
- Participant has an active or past medical history of leptomeningeal disease
- Sub-study: Participants who have received prior treatment for epidermal growth factor receptor (EGFR)-induced DAEIs with JAK inhibitors (for Cohort A) or calcineurin inhibitors (for Cohort B)
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (93)
Ironwood Cancer and Research Center
Chandler, Arizona, 85224, United States
City of Hope
Duarte, California, 91010, United States
Providence Fullerton
Fullerton, California, 92835, United States
Los Angeles Cancer Network
Glendale, California, 91204, United States
City of Hope Seacliff
Huntington Beach, California, 92648, United States
City of Hope Orange County Lennar Foundation Cancer Center
Irvine, California, 92618, United States
City of Hope Long Beach Elm
Long Beach, California, 90813, United States
Cancer and Blood Specialty Clinic
Los Alamitos, California, 90720, United States
Keck Hospital of USC
Los Angeles, California, 90033, United States
USC Norris Oncology Hematology Newport Beach
Newport Beach, California, 92663, United States
Kaiser Permanente Oakland Medical Center
Oakland, California, 94611, United States
Kaiser Permanente Roseville Medical Center
Roseville, California, 95661, United States
Kaiser Permanente San Francisco Medical Center
San Francisco, California, 94115, United States
Kaiser Permanente Santa Clara Medical Center
Santa Clara, California, 95051, United States
City of Hope South Pasadena
South Pasadena, California, 91030, United States
Kaiser Permanente Northern California
Vallejo, California, 94589, United States
Kaiser Permanente Walnut Creek Medical Center
Walnut Creek, California, 94596, United States
University Cancer & Blood Center
Athens, Georgia, 30607, United States
Hope and Healing Care
Hinsdale, Illinois, 60521, United States
Oncology Hematology Associates
Springfield, Missouri, 65807, United States
Renown Health Medical Oncology
Reno, Nevada, 89502, United States
Hunterdon Hematology Oncology
Flemington, New Jersey, 08822, United States
Clinical Research Alliance Inc
Westbury, New York, 11590, United States
Regional Medical Oncology Center
Wilson, North Carolina, 27893, United States
University Hospitals Cleveland Medical Center
Cleveland, Ohio, 44106, United States
Virginia Cancer Specialists
Fairfax, Virginia, 22031, United States
Valley Medical Center
Renton, Washington, 98055, United States
Gundersen Health System
West Salem, Wisconsin, 54669, United States
Hospital Italiano de Buenos Aires
Buenos Aires, C1199, Argentina
IADT Instituto Argentino de Diagnostico y Tratamiento
CABA, C1122, Argentina
Centro Medico Austral
Capital Federal, C1017, Argentina
Hospital Italiano de La Plata
La Plata, B1900AXI, Argentina
Hospital Privado de la Comunidad
Mar del Plata, B7602, Argentina
CTO Centro De Tratamento Oncologico LTDA
Belém, 66.073-005, Brazil
Santa Casa de Misericordia de Belo Horizonte
Belo Horizonte, 30150-221, Brazil
Liga Paranaense de Combate ao Cancer
Curitiba, 81520-060, Brazil
Fundacao Doutor Amaral Carvalho
Jaú, 17.210-080, Brazil
Hospital Nossa Senhora da Conceicao S A
Porto Alegre, 91350 200, Brazil
Nucleo de Oncologia da Bahia Oncoclinicas
Salvador, 40170 070, Brazil
Hospital Ana Nery Santa Cruz do Sul
Santa Cruz do Sul, 96835-100, Brazil
Fundacao Faculdade de Medicina - Instituto do Cancer do Estado de Sao Paulo
São Paulo, 01246 000, Brazil
Fundacao Antonio Prudente A C Camargo Cancer Center
São Paulo, 01509 900, Brazil
Servicos de Tratamento ao Cancer de Taubate LTDA - Instituto do Cancer Brasil Unidade Taubate
Taubaté, 12030-200, Brazil
Associacao Feminina de Educacao e Combate ao Cancer Hospital Santa Rita de Cassia
Vitória, 29043-260, Brazil
Changzhou No 2 Peoples Hospital
Changzhou, 213004, China
West China Hospital
Chengdoucun, 610041, China
Sichuan Cancer Hospital
Chengdu, 610041, China
The First Affiliated Hospital Sun Yat sen University
Guangzhou, 510080, China
The First Affiliated Hospital Zhejiang University School of Medicine
Hangzhou, 310003, China
Harbin medical university cancer hospital
Harbin, 150040, China
Huizhou Municipal Central Hospital
Huizhou, 516001, China
Zhongda Hospital Southeast University
Nanjing, 210000, China
Fudan University Shanghai Cancer Center
Shanghai, 200032, China
The First Affiliated Hospital of Xian Jiaotong University
Xi'an, 710061, China
Henan Cancer Hospital
Zhengzhou, 450008, China
Hopital Nord
Marseille, 13915, France
Hopital PASTEUR
Nice, 06001, France
Institut Curie
Paris, 75005, France
Universitaetsklinikum der RWTH Aachen
Aachen, 52074, Germany
Kliniken Essen-Mitte
Essen, 45136, Germany
Universitaetsklinikum Giessen und Marburg GmbH
Giessen, 35392, Germany
Thoraxklinik am Universitatsklinikum Heidelberg
Heidelberg, 69126, Germany
Klinikum Kassel GmbH
Kassel, 34125, Germany
Universitaetsklinikum Schleswig Holstein Campus Kiel
Kiel, 24105, Germany
Hospital Pulau Pinang
George Town, 10450, Malaysia
University Malaya Medical Centre
Kuala Lumpur, 59100, Malaysia
Hospital Tengku Ampuan Afzan
Kuantan, 25100, Malaysia
Hospital Umum Sarawak
Kuching, 93586, Malaysia
Chungbuk National University Hospital
Cheongju-si, 28644, South Korea
Gachon University Gil Medical Center
Incheon, 21565, South Korea
Severance Hospital Yonsei University Health System
Seoul, 03722, South Korea
Hosp Univ A Coruna
A Coruña, 15006, Spain
Hosp. Gral. Univ. de Alicante
Alicante, 03010, Spain
Hosp. Univ. Quiron Dexeus
Barcelona, 08028, Spain
Hosp Univ Vall D Hebron
Barcelona, 08035, Spain
Hosp. Univ. de Jaen
Jaén, 23007, Spain
Hosp. Univ. Lucus Augusti
Lugo, 27003, Spain
Hosp. Gral. Univ. Gregorio Maranon
Madrid, 28007, Spain
Hosp Regional Univ de Malaga
Málaga, 29010, Spain
Hosp. Ntra. Sra. de Valme
Seville, 41014, Spain
National Taiwan University Hospital Hsin Chu Branch
Hsinchu, 30059, Taiwan
Chang Gung Memorial Hospital
Kaohsiung City, 833, Taiwan
Taichung Veterans General Hospital
Taichung, 40705, Taiwan
National Taiwan University Hospital
Taipei, 100, Taiwan
Linkou Chang Gung Memorial Hospital
Taoyuan City, 333, Taiwan
Adana City Hospital
Adana, 1060, Turkey (Türkiye)
Gulhane Training and Research Hospital
Ankara, 06010, Turkey (Türkiye)
Gazi University Hospital
Ankara, 06560, Turkey (Türkiye)
Ankara Bilkent City Hospital
Ankara, 6800, Turkey (Türkiye)
Bakirkoy Training and Research Hospital
Istanbul, 34147, Turkey (Türkiye)
I A U VM Medical Park Florya Hastanesi
Istanbul, 34295, Turkey (Türkiye)
Ege University Medical Faculty
Izmir, 35100, Turkey (Türkiye)
Ondokuz Mayis University
Samsun, 55420, Turkey (Türkiye)
Related Publications (1)
Cho BC, Li W, Spira AI, Sauder M, Feldman J, Bozorgmehr F, Mak M, Smith J, Voon PJ, Liu B, Tian P, Tan JL, Yang CT, Shih JY, Karadurmus N, Cundom JE, Bertollo G, Cicin I, Nieva J, Ortega-Granados AL, Tomasini P, Nguyen D, Felip E, Schuchard J, Murphy SP, Anderson BG, Romero T, Xia Y, Sheng S, Bauml JM, Mahadevia PJ, Kam J, Nematian-Samani M, Simoes J, Wildgust M, Girard N. Enhanced Versus Standard Dermatologic Management With Amivantamab-Lazertinib in EGFR-Mutated Advanced NSCLC: The COCOON Global Randomized Controlled Trial. J Thorac Oncol. 2025 Oct;20(10):1517-1530. doi: 10.1016/j.jtho.2025.07.117. Epub 2025 Sep 9.
PMID: 40923969DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- STUDY DIRECTOR
Janssen Research & Development, LLC Clinical Trial
Janssen Research & Development, LLC
Study Design
- Study Type
- interventional
- Phase
- phase 2
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- INDUSTRY
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
November 2, 2023
First Posted
November 7, 2023
Study Start
February 16, 2024
Primary Completion (Estimated)
May 31, 2027
Study Completion (Estimated)
January 31, 2032
Last Updated
June 5, 2026
Record last verified: 2026-06
Data Sharing
- IPD Sharing
- Will share
The data sharing policy of Johnson \& Johnson Innovative Medicine is available at www.innovativemedicine.jnj.com/our-innovation/clinical-trials/transparency. As noted on this site, requests for access to the study data can be submitted through Yale Open Data Access (YODA) Project site at yoda.yale.edu