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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) mutations. 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 orally twice daily. Medication should be taken with or without food. Tablets must be swallowed whole and not crushed or chewed. If a dose is missed, it should be taken unless the next dose is due within 6 hours.
## Pediatric Dosing
Safety and effectiveness in pediatric patients have not been established. There is no standard pediatric dosing regimen.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment recommended for mild or moderate impairment. Data for severe impairment are limited.
* **Hepatic Impairment:** No adjustment for mild hepatic impairment. Use with caution in moderate to severe impairment.
* **Toxicity-Related:** Dose reductions (300 mg BID, then 200 mg BID) are required for Grade 3 or higher adverse reactions (e.g., interstitial lung disease/pneumonitis, hepatotoxicity, or photosensitivity). Discontinue permanently if the patient cannot tolerate 200 mg BID.
## Contraindications
There are no absolute contraindications listed in the FDA-approved labeling, though severe hypersensitivity to the active ingredient or excipients precludes use.
## Adverse Effects
Common adverse effects include peripheral edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite. Clinically significant risks include interstitial lung disease (ILD)/pneumonitis, hepatotoxicity, and photosensitivity reactions (patients should be advised to limit direct sun exposure).
## Key Drug Interactions
* **Strong CYP3A Inducers:** Avoid co-administration. Use of potent inhibitors (e.g., rifampin) can decrease capmatinib concentrations.
* **Strong CYP3A Inhibitors:** Monitor toxicity closely; consider dose reduction if co-administration is necessary.
* **MATE1/MATE2-K Substrates:** Capmatinib may increase the plasma concentration of substrates of the MATE1 and MATE2-K transporters (e.g., metformin). Monitor for signs of toxicity.
## Monitoring
* **Liver Function:** Monitor ALT/AST and bilirubin at baseline and as clinically indicated.
* **Pulmonary:** Monitor for new or worsening respiratory symptoms (potential for ILD/pneumonitis).
* **Clinical Status:** Periodically assess for evidence of peripheral edema and monitor for signs of photosensitivity.
## Clinical Pearls
* Verify METex14 mutation status using an FDA-approved test prior to initiation.
* Advise patients to use sun protection (clothing, sunscreen) due to the risk of photosensitivity.
* If a patient develops suspected ILD/pneumonitis, permanently discontinue the drug if no other cause is identified.
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**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 medication.
