Optimizing Amivantamab Treatment in NSCLC: Dr. Carlisle Shares Insights From ASCO 2025 Session

Jennifer Carlisle, MD, of the Winship Cancer Institute of Emory University, joined Lung Cancers Today to discuss her presentation at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting.
Dr. Carlisle presented a talk on bispecific T-cell engagers, amivantamab, and the multidimensional impact of toxicity management during the session titled “Striking the Balance: Optimizing Amivantamab Use and Handling Its Adverse Effects in Patients With Lung Cancer.”
“I'm very excited that we're offering this education session at ASCO 2025 because the field of lung cancer—both non–small cell and small cell—is moving very quickly,” Dr. Carlisle said. “The practical implications and hot tips on how to manage side effects aren't necessarily addressed in the big clinical trial publications.”
Optimizing amivantamab use is critical, as it now has an indication in relapsed EGFR-mutated non–small cell lung cancer after treatment with osimertinib and in frontline treatment in combination with lazertinib.
“Now that we're seeing a lot more patients [treated] with amivantamab, we're having more experiences. … Fortunately, there have been recent publications and randomized data that show us better ways to reduce some of these side effects, namely the infusion reactions and the dermatologic toxicity,” Dr. Carlisle said. “In terms of the dermatologic toxicity with amivantamab, it's slightly different than [what] we see with other EGFR-targeted therapies. Specifically, there's a predilection for scalp rash that can be very difficult to manage.”
She explained that the COCOON trial, which was presented at the European Lung Cancer Congress 2025, evaluated an enhanced dermatologic regimen for patients receiving the treatment and compared it with standard-of-care practices for EGFR-targeted therapies and bispecific antibodies, which can “vary widely.”
“Some institutions use a lot of prophylactic measures; others are more reactive, and they may include steroids, antibiotics, and other topical administrations,” Dr. Carlisle said.
The enhanced dermatologic regimen evaluated in COCOON involves taking oral doxycycline or minocycline, 100 mg, twice daily for weeks 1 through 12, then using 1% topical clindamycin lotion on the scalp daily before bedtime for weeks 13 through 52. For weeks 1 through 52, patients also wash their hands and feet once daily with 4% chlorhexidine and apply a ceramides-based moisturizer to the body and face at least once daily.
“At ELCC, we saw the results of this trial, the COCOON data, and although it was an early look, they found a 50% reduction in the grade 2 or higher dermatologic adverse events and this had specifically helped with the scalp rash, with a 70% reduction there,” Dr. Carlisle said. “Also, patients were able to stay on treatment longer. There were less dose reductions and discontinuations with the supportive care regimen.”
In addition to COCOON, there are also other strategies under evaluation, including the use of dexamethasone before infusion in the SKIPPr trial, Dr. Carlisle explained. She shared what she hopes that attendees of the presentation learn and take back to their practices.
“I hope that attendees realize that there are options to make it more tolerable,” she said. “Patients may still have unmanaged side effects despite these supportive care regimens. I also strongly encourage early dermatology referral and close collaboration with multidisciplinary care. Some patients do need further treatment options on top of the COCOON regimen.”