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# Tabrecta (capmatinib)
## Overview
Tabrecta 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 MET exon 14 skipping as detected by an FDA-approved test.
## Adult Dosing
The recommended dose is 400 mg (two 200 mg tablets) administered orally twice daily. Tablets should be swallowed whole and not crushed or chewed. Administer without regard to food.
## Pediatric Dosing
Safety and effectiveness have not been established in pediatric patients.
## Dose Adjustments
**Hepatic Impairment:** Avoid use in patients with severe hepatic impairment (Child-Pugh B or C). No adjustment required for mild impairment.
**Renal Impairment:** No adjustment required for mild to moderate impairment. Use caution in severe renal impairment.
**Toxicity:** If needed for adverse reactions (e.g., pneumonitis, hepatotoxicity), reduce the dose to 300 mg twice daily, then 200 mg twice daily. Discontinue if unable to tolerate 200 mg twice daily.
## Contraindications
There are no formal contraindications listed in the FDA-approved prescribing information.
## Adverse Effects
Common side effects include peripheral edema (incidence >50%), nausea, fatigue, musculoskeletal pain, dyspnea, vomiting, decreased appetite, and diarrhea. Serious risks include interstitial lung disease (ILD)/pneumonitis, hepatotoxicity, and photosensitivity.
## Key Drug Interactions
* **Strong CYP3A inhibitors:** Avoid co-administration. If unavoidable, monitor closely for toxicity; consider dose reduction.
* **Strong CYP3A inducers:** Avoid co-administration. These significantly decrease capmatinib concentrations.
* **MATE1/MATE2-K substrates:** Capmatinib inhibits MATE transporters; monitor for increased toxicity of co-administered substrates (e.g., metformin).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms indicative of ILD/pneumonitis.
* **Hepatic:** Monitor ALT/AST levels at baseline, every 2 weeks for the first month, then monthly thereafter.
* **Fluid Status:** Monitor for edema; utilize diuretics or compression stockings as clinically indicated.
## Clinical Pearls
* **Photosensitivity:** Advise patients to use sun protection (hats, sunscreen) while taking the medication.
* **Nausea Management:** Consider prophylactic antiemetics if the patient experiences gastrointestinal intolerance.
* **Confirmation:** Ensure MET exon 14 skipping mutation is confirmed by a validated companion diagnostic test prior to initiation.
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**Disclaimer:** This information is intended for educational purposes for healthcare professionals. Clinical practice guidelines and drug information evolve; always verify the current prescribing information via the manufacturer’s official package insert or a verified clinical database (e.g., Lexicomp, UpToDate) before prescribing or administering medication.
