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# Tabrecta (capmatinib) ## Overview Capmatinib is a tyrosine kinase inhibitor (TKI) that targets MET (mesenchymal-epithelial transition) exon 14 (METex14) skipping mutations. It is an oral, potent, and selective MET inhibitor. ## Primary Indications Treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) harboring a MET exon 14 skipping mutation. ## Adult Dosing The recommended dose is **400 mg administered orally twice daily** (total daily dose: 800 mg). Tablets should be swallowed whole; do not crush, chew, or break. Administer with or without food. If a dose is missed, skip the missed dose and resume at the next scheduled time. ## Pediatric Dosing Safety and effectiveness have not been established in pediatric patients. ## Dose Adjustments **For Adverse Reactions (e.g., Pneumonitis, ALT/AST elevation, Peripheral Edema):** * First dose reduction: 300 mg twice daily. * Second dose reduction: 200 mg twice daily. * Discontinue if unable to tolerate 200 mg twice daily. * **Hepatic Impairment:** No adjustment required for mild (Child-Pugh A) or moderate (Child-Pugh B) impairment. Safety in severe (Child-Pugh C) impairment is unknown. * **Renal Impairment:** No adjustment required for mild or moderate impairment. ## Contraindications No specific contraindications are listed in the FDA-approved labeling. ## Adverse Effects * **Common (>20%):** Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite. * **Serious:** Interstitial lung disease (ILD)/pneumonitis (can be fatal), hepatotoxicity, photosensitivity reaction. ## Key Drug Interactions * **Strong CYP3A4 Inhibitors:** May increase capmatinib exposure; monitor more frequently for toxicity. * **Strong CYP3A4 Inducers:** Significantly reduce capmatinib plasma concentrations; avoid concomitant use. * **P-gp/BCRP Substrates:** Capmatinib is a sensitive substrate for these transporters; clinical implications are monitor-dependent. ## Monitoring * **Lung function:** Monitor for new or worsening respiratory symptoms; withhold if ILD/pneumonitis is suspected. * **Hepatic function:** Obtain baseline ALT/AST/bilirubin levels and monitor every 2 weeks during the first month, then monthly thereafter. * **Edema:** Monitor for fluid retention or signs of heart failure. ## Clinical Pearls * Verify METex14 mutation status using an FDA-approved test prior to initiation. * Patients should be advised to take precautions against sun exposure (e.g., protective clothing, sunscreen) due to the risk of photosensitivity. * If a patient experiences significant peripheral edema, the addition of diuretics or dose reduction of capmatinib may be necessary. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Dosing protocols may vary by institution. Always verify the most current prescribing information (package insert) and clinical guidelines before prescribing or administering medication.