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# Tabrecta (capmatinib)
## Overview
Tabrecta (capmatinib) is a potent, selective, ATP-competitive oral inhibitor of the MET receptor tyrosine kinase. It is specifically designed to target tumors harboring MET exon 14 (METex14) skipping alterations.
## Primary Indications
Treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have a mutation that leads to mesenchymal-epithelial transition (MET) exon 14 skipping as detected by an FDA-approved test.
## Adult Dosing
The recommended dose is 400 mg (two 200 mg tablets) orally twice daily with or without food. Tablets should be swallowed whole; do not break, crush, or chew.
## Pediatric Dosing
Safety and effectiveness in pediatric patients have not been established. There is no established pediatric dosing.
## Dose Adjustments
* **Hepatic Impairment:** No adjustment required for mild (Child-Pugh A) or moderate (Child-Pugh B) impairment. Use with caution in severe (Child-Pugh C) impairment, as data are limited.
* **Renal Impairment:** No adjustment required for mild to moderate renal impairment.
* **Adverse Reactions:** If dose reduction is necessary for toxicity, reduce to 300 mg twice daily, then to 200 mg twice daily. Discontinue permanently if unable to tolerate 200 mg twice daily.
## Contraindications
There are no absolute contraindications listed in the manufacturer labeling.
## Adverse Effects
* **Common:** Peripheral edema (50%+), nausea, fatigue, vomiting, dyspnea, and decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis (potentially fatal), hepatotoxicity (increased ALT/AST), and photosensitivity.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** Strong inhibitors (e.g., ketoconazole, clarithromycin) may increase capmatinib plasma concentrations. Monitor for increased toxicity.
* **CYP3A4 Inducers:** Strong inducers (e.g., rifampin, carbamazepine) may decrease capmatinib concentrations. Avoid concomitant use; consider alternative agents.
* **MATE1/MATE2-K Substrates:** Capmatinib may inhibit MATE transporters. Monitor for increased concentrations of co-administered substrates (e.g., metformin).
## Monitoring
* **Liver Function:** Baseline liver function tests (LFTs) and monitor every 2 weeks during the first month, then once monthly or as clinically indicated.
* **Pulmonary:** Monitor for new or worsening respiratory symptoms (e.g., dyspnea, cough, fever) indicative of ILD/pneumonitis.
* **Clinical:** Monitor for peripheral edema and signs of toxicity.
## Clinical Pearls
* **Administration:** Tablets must be swallowed whole. If a dose is missed, omit the dose unless the next dose is due in more than 6 hours.
* **Photosensitivity:** Instruct patients to use sun protection (e.g., sunscreen, protective clothing) throughout treatment.
* **Pregnancy/Lactation:** May cause fetal harm; advise effective contraception during treatment and for 1 week after the last dose. Breastfeeding is not recommended during therapy.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information, institutional guidelines, and local protocols before initiating therapy. Consult the most recent FDA-approved package insert or a clinical pharmacotherapy database (e.g., Lexicomp, Clinical Pharmacology) for the latest updates.
