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# Tabrecta (capmatinib)
## Overview
Tabrecta is a kinase inhibitor that targets mesenchymal-epithelial transition (MET) exon 14 skipping mutation-positive metastatic non-small cell lung cancer (NSCLC).
## Primary Indications
Treatment of adult patients with metastatic NSCLC whose tumors have a mutation that leads to mesenchymal-epithelial transition (MET) exon 14 skipping.
## Adult Dosing
400 mg orally twice daily with or without food.
* **Administration:** Swallow tablets whole. Do not break, crush, or chew. If a dose is missed by >6 hours, skip the dose and resume the next dose at the scheduled time.
## Pediatric Dosing
Safety and effectiveness have not been established in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** No adjustment required for mild (Child-Pugh A) or moderate (Child-Pugh B) impairment. Use is not recommended in severe (Child-Pugh C) impairment.
* **Renal Impairment:** No adjustment required for mild to moderate impairment. Use caution in severe impairment; pharmacokinetic data are insufficient.
* **Adverse Reaction Management:** If toxicities occur (e.g., pneumonitis, interstitial lung disease, hepatotoxicity), hold dose, reduce to 300 mg BID, then 200 mg BID as needed. Permanently discontinue if unable to tolerate 200 mg BID.
## Contraindications
None established in current FDA labeling.
## Adverse Effects
* **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis (potential for fatal outcomes), hepatotoxicity (elevated ALT/AST), photosensitivity.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** Strong inhibitors (e.g., ketoconazole) may increase capmatinib plasma concentrations. Monitor closely for toxicities.
* **CYP3A4 Inducers:** Strong inducers (e.g., rifampin) may decrease capmatinib effectiveness. Avoid concomitant use; consider alternative agents.
* **CYP1A2 Substrates:** Capmatinib is a moderate inhibitor of CYP1A2. Use caution with substrates with a narrow therapeutic index (e.g., tizanidine, theophylline).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms suggestive of ILD/pneumonitis during treatment.
* **Hepatic:** Monitor ALT/AST at baseline and every two weeks for the first three months, then monthly thereafter.
* **General:** Monitor for signs of peripheral edema or signs of photosensitivity.
## Clinical Pearls
* Obtain FDA-approved companion diagnostic testing for MET exon 14 skipping mutations prior to initiation.
* Advise patients to limit direct sunlight exposure and use sun protection (hats, SPF 30+) due to potential photosensitivity reactions.
* If a patient develops Grade 2 or higher pneumonitis, discontinue permanently.
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*Disclaimer: This information is for educational purposes for healthcare professionals. Clinical practice guidelines and drug labeling may change. Always verify current prescribing information, institutional protocols, and specific patient factors before confirming a medication regimen.*
