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# Tabrecta (Capmatinib)
## Overview
Capmatinib is a kinase inhibitor that targets the mesenchymal-epithelial transition (MET) exon 14 skipping mutation. 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.
## 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 have not been established in pediatric patients.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is required for mild to moderate renal impairment. Data for severe impairment are limited.
* **Hepatic Impairment:** No dose adjustment is required for mild hepatic impairment. Use with caution in moderate or severe impairment (monitor closely).
* **Toxicity-related Dosing:** Interrupt or discontinue for Grade 3 or 4 adverse reactions (e.g., pneumonitis, interstitial lung disease, or elevated LFTs). If toxicity resolves to Grade 1 or baseline, resume at a reduced dose of 300 mg twice daily. Discontinue permanently if unable to tolerate 300 mg twice daily.
## Contraindications
None established in formal labeling, though hypersensitivity to the drug or any components is a clinical contraindication.
## Adverse Effects
Common (≥20%): Edema (peripheral), nausea, fatigue, vomiting, dyspnea, decreased appetite, musculoskeletal pain, elevated creatinine, and elevated liver enzymes (ALT/AST).
Serious: Interstitial lung disease (ILD)/pneumonitis, hepatotoxicity, and photosensitivity.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** Strong inhibitors (e.g., ketoconazole) may increase capmatinib exposure. Avoid co-administration; if unavoidable, monitor closely.
* **CYP3A4 Inducers:** Strong inducers (e.g., rifampin) may decrease capmatinib efficacy. Avoid co-administration.
* **MATE1/MATE2-K Substrates:** Capmatinib may increase the concentration of drugs that are substrates of MATE1/MATE2-K (e.g., metformin). Monitor for signs of toxicity.
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms; withhold treatment if ILD/pneumonitis is suspected.
* **Hepatic:** Monitor ALT/AST and bilirubin at baseline and during treatment.
* **Renal:** Monitor serum creatinine periodically.
* **Photosensitivity:** Counsel patients to use sun protection as risk of sensitivity increases.
## Clinical Pearls
* **Missed Dose:** If a dose is missed, patients should not take an extra dose; take the next dose at the scheduled time.
* **Administration:** Ensure patients swallow tablets whole.
* **Efficacy:** Effectiveness is dependent on the accurate identification of MET exon 14 skipping mutations via an FDA-approved test or validated laboratory assay.
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**Educational Disclaimer:** This information is for educational purposes only and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and FDA/EMA labeling before dosing.
