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# Tabrecta (capmatinib)
## Overview
Tabrecta is a kinase inhibitor that targets the mesenchymal-epithelial transition (MET) receptor. It is an orally administered medication primarily used in the treatment of non-small cell lung cancer (NSCLC) harboring specific genetic mutations.
## 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 administered orally twice daily. It may be taken with or without food. Capsules should be swallowed whole; do not break, crush, or chew.
## Pediatric Dosing
Safety and effectiveness have not been established in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** No specific adjustment for mild to moderate impairment. Use with caution in severe hepatic impairment.
* **Renal Impairment:** No specific adjustment for mild to moderate impairment.
* **Toxicity:** If treatment is withheld due to adverse reactions, the dose may be reduced to 300 mg twice daily, then to 200 mg twice daily. Discontinue permanently if the patient cannot tolerate 200 mg twice daily.
## Contraindications
There are no formal contraindications; however, use should be avoided in patients with a history of hypersensitivity to capmatinib or any component of the formulation.
## Adverse Effects
* **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis, hepatotoxicity (elevated ALT/AST), and photosensitivity.
## Key Drug Interactions
* **Strong CYP3A Inhibitors:** May increase capmatinib exposure; monitor for increased toxicity.
* **Strong CYP3A Inducers:** May decrease capmatinib exposure; avoid concomitant use.
* **Sensitive CYP-substrates:** Capmatinib may inhibit CYP1A2, CYP2C8, and CYP2C9; monitor patients taking medications metabolized by these pathways (e.g., warfarin, tizanidine).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms indicative of ILD/pneumonitis during treatment.
* **Hepatic:** Monitor ALT/AST levels at baseline and monthly during therapy.
* **Dermatologic:** Advise patients to use sun protection (sunscreen, protective clothing) due to photosensitivity risk.
## Clinical Pearls
* MET exon 14 skipping mutation must be confirmed by an FDA-approved assay prior to initiation.
* If a dose is missed, it should be taken as soon as remembered unless the next dose is due within 6 hours. Do not take two doses at once to make up for a missed dose.
* Patients should be counseled on the risk of interstitial lung disease and instructed to report cough, fever, or difficulty breathing immediately.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice protocols vary. Always verify current prescribing information, package inserts, and institutional guidelines before prescribing or administering medication.
