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# Tabrecta (capmatinib)
## Overview
Tabrecta is a kinase inhibitor that targets the MET receptor tyrosine kinase. It is highly selective for MET exon 14 skipping mutation-positive non-small cell lung cancer (NSCLC).
## Primary Indications
Treatment of adult patients with metastatic NSCLC whose tumors have a mutation that leads to mesenchymal-epithelial transition (MET) exon 14 skipping.
## Adult Dosing
* **Recommended dose:** 400 mg orally twice daily (total daily dose of 800 mg).
* **Administration:** May be taken with or without food. Swallow tablets whole; do not break, crush, or chew. If a dose is missed, skip the missed dose unless the next dose is more than 6 hours away.
## Pediatric Dosing
* **Safety and efficacy:** Not established in pediatric patients.
## Dose Adjustments
* **Hepatic impairment:** No adjustment for mild/moderate impairment. Avoid in severe hepatic impairment.
* **Renal impairment:** No adjustment for mild/moderate impairment. Use caution in severe renal impairment (no specific dose established).
* **Toxicity-based:** For adverse reactions (e.g., ILD/pneumonitis, hepatotoxicity), interrupt therapy for 3 weeks and resume at a reduced dose (200 mg BID) once resolved. Discontinue permanently if toxicity persists.
## Contraindications
* None established.
## Adverse Effects
* **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite, and musculoskeletal pain.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis (can be fatal), hepatotoxicity, and photosensitivity.
## Key Drug Interactions
* **CYP3A4 inhibitors:** Strong inhibitors (e.g., ketoconazole) may increase plasma concentrations; monitor closely.
* **CYP3A4 inducers:** Strong inducers (e.g., rifampin) may decrease efficacy; avoid concomitant use.
* **Substrates of CYP3A4:** Capmatinib may inhibit CYP3A4; monitor patients receiving sensitive CYP3A substrates with narrow therapeutic indices.
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms indicative of ILD/pneumonitis.
* **Hepatic:** Monitor ALT/AST at baseline and regularly during treatment.
* **Dermatologic:** Advise patients to use sun protection (clothing/sunscreen) due to risk of photosensitivity.
## Clinical Pearls
* **Companion Diagnostic:** Patients must be selected based on a validated test for MET exon 14 skipping mutations prior to initiation.
* **Formulation:** Ensure the tablet is kept in the original bottle with the included desiccant to maintain stability.
* **Pregnancy:** May cause fetal harm; advise contraception for females of reproductive potential and males with female partners.
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*Disclaimer: This information is for educational purposes only and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and specific patient factors through primary pharmaceutical resources (e.g., FDA labels, Lexicomp, or UpToDate) before prescribing or administering medication.*
