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# Tabrecta (capmatinib) ## Overview Tabrecta is a kinase inhibitor that targets the mesenchymal-epithelial transition (MET) receptor, including exon 14 skipping (METex14) alterations. It is an oral, selective MET inhibitor. ## 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 dosage is 400 mg administered orally twice daily. Medication may be taken with or without food. Tablets must be swallowed whole and not broken, crushed, or chewed. ## Pediatric Dosing Safety and effectiveness in pediatric patients have not been established. There is no recommended pediatric dose. ## 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; clinical data is limited. **Renal Impairment:** No dose adjustment required for mild-to-moderate renal impairment. **Adverse Reactions:** If dose reduction is required due to toxicity, reduce to 300 mg twice daily, then to 200 mg twice daily. Discontinue if patient cannot tolerate 200 mg twice daily. ## Contraindications No specific contraindications listed in the FDA-approved labeling. ## Adverse Effects Common (≥20%): Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite, musculoskeletal pain, and increased creatinine. Serious: Interstitial lung disease (ILD)/pneumonitis, hepatotoxicity, and photosensitivity. ## Key Drug Interactions * **Strong CYP3A inhibitors:** May increase capmatinib exposure; monitor closely for toxicity. * **Strong CYP3A inducers:** May decrease capmatinib exposure; avoid concomitant use. * **MATE1/MATE2-K substrates:** Capmatinib may inhibit these transporters; monitor for toxicities of drugs that are sensitive substrates (e.g., metformin). ## Monitoring * **Pulmonary:** Monitor for new or worsening respiratory symptoms; withhold treatment if ILD/pneumonitis is suspected. * **Hepatic:** Monitor ALT/AST levels prior to start and monthly during treatment. * **Renal:** Monitor serum creatinine periodically. * **Skin:** Advise patients to use sun protection/avoid excessive sunlight due to risk of photosensitivity. ## Clinical Pearls * If a dose is missed, do not take an extra dose; skip the missed dose and take the next dose at the scheduled time. * The high frequency of peripheral edema (up to 50%) often requires proactive management (e.g., compression garments, dose interruption). * Presence of METex14 mutation must be confirmed via a validated companion diagnostic prior to initiation. *** **Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Clinical practice and local protocols vary. Always verify current prescribing information, package inserts, and institutional guidelines before prescribing or administering any medication.