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# Tabrecta (capmatinib)
## Overview
Tabrecta (capmatinib) is a high-affinity, selective, reversible inhibitor of the MET (mesenchymal-epithelial transition) receptor tyrosine kinase. It is utilized in the treatment of non-small cell lung cancer (NSCLC) harboring specific genetic alterations.
## 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. It may be taken with or without food. Tablets must be swallowed whole and not crushed, chewed, or split. If a dose is missed by less than 6 hours, take the missed dose; if more than 6 hours have passed, skip the dose.
## Pediatric Dosing
Safety and efficacy have not been established in patients younger than 18 years.
## Dose Adjustments
* **Hepatic Impairment:** No specific adjustment for mild to moderate impairment. Not studied in severe impairment.
* **Renal Impairment:** No specific adjustment for mild to moderate impairment. Not studied in severe impairment.
* **Toxicity:** Dose modifications (reduction to 300 mg BID, then 200 mg BID, or permanent discontinuation) are required for Grade 3 or 4 adverse reactions, including pneumonitis, hepatotoxicity, and interstitial lung disease (ILD).
## Contraindications
There are no absolute contraindications listed in the FDA-approved labeling, though hypersensitivity to the drug or any of its components precludes use.
## Adverse Effects
* **Common:** Peripheral edema (very common), nausea, fatigue, vomiting, dyspnea, and decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis, hepatotoxicity (elevated ALT/AST), and photosensitivity.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** May increase capmatinib plasma concentrations. Monitor for toxicity; use alternative medications if possible.
* **CYP3A4 Inducers:** May decrease capmatinib plasma concentrations. Avoid strong CYP3A4 inducers (e.g., rifampin, carbamazepine).
* **P-gp Substrates:** Capmatinib may increase exposure of sensitive P-glycoprotein (P-gp) substrates (e.g., digoxin).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms; discontinue if ILD/pneumonitis is suspected.
* **Hepatic:** Monitor ALT/AST levels prior to start and monthly during treatment.
* **Dermatologic:** Advise patients to use sun protection (hats, sunscreen) to minimize risk of photosensitivity.
## Clinical Pearls
* Molecular testing for MET exon 14 skipping is mandatory prior to initiation.
* Peripheral edema is highly prevalent; consider appropriate management strategies (e.g., dose interruptions or diuretics).
* Patients should be counseled on photosensitivity precautions throughout treatment.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information using official drug labels (e.g., FDA Package Insert), institutional protocols, or clinical decision support tools before prescribing or administering medication.
