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# Tabrecta (Capmatinib) ## Overview Capmatinib is a kinase inhibitor that targets MET (mesenchymal-epithelial transition) exon 14 skipping mutation. It is a potent, selective oral inhibitor of the MET receptor tyrosine kinase. ## Primary Indications Treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have a mutation that leads to MET exon 14 skipping as detected by an FDA-approved test. ## Adult Dosing The recommended dose is 400 mg administered orally twice daily with or without food. Tablets must be swallowed whole and not crushed, broken, or chewed. If a dose is missed, it should not be taken if there are less than 6 hours until the next scheduled dose. ## Pediatric Dosing Safety and effectiveness have not been established in pediatric patients. Use is not recommended. ## Dose Adjustments * **Hepatic Impairment:** Reduce dose to 200 mg orally twice daily in patients with severe hepatic impairment (Child-Pugh B or C). No adjustment is required for mild impairment (Child-Pugh A). * **Toxicity-related:** Reduce dose to 300 mg twice daily, then 200 mg twice daily, or discontinue based on severity of adverse reactions (e.g., pneumonitis, elevated liver enzymes, or peripheral edema). ## Contraindications There are no formal contraindications listed in the FDA-approved labeling, other than hypersensitivity to the drug or its components. ## Adverse Effects * **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite. * **Serious:** Interstitial lung disease (ILD)/pneumonitis (can be fatal), hepatotoxicity, and photosensitivity reactions. Patients should use sun protection. ## Key Drug Interactions * **Strong CYP3A inhibitors:** Co-administration may increase capmatinib plasma concentrations. Monitor closely for toxicity. * **Strong CYP3A inducers:** Co-administration may decrease capmatinib concentrations. Avoid concomitant use; if unavoidable, consider dose increase of capmatinib per clinical judgment. * **MATE1/MATE2-K substrates:** Capmatinib may inhibit these transporters; use caution with substrates like metformin. ## Monitoring * Baseline and periodic liver function tests (ALT/AST and bilirubin). * Monitor for new or worsening respiratory symptoms (e.g., cough, dyspnea) suggesting ILD/pneumonitis. * Monitor clinical symptoms of edema. ## Clinical Pearls * Capmatinib is a potent inhibitor of MET. Ensure the presence of the MET exon 14 skipping mutation via validated next-generation sequencing before initiation. * Advise patients to avoid prolonged sun exposure and wear protective clothing/sunscreen due to the risk of photosensitivity. * If treatment-related pneumonitis occurs, permanently discontinue the drug. *** *Disclaimer: This information is for educational purposes only. Clinical pharmacists remain responsible for verifying current, site-specific drug information, package inserts, and local protocols before initiating or recommending therapy.*