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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 antineoplastic agent used for patients with non-small cell lung cancer (NSCLC).
## 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. Continue treatment until disease progression or unacceptable toxicity.
## Pediatric Dosing
Safety and effectiveness in pediatric patients have not been established. Use is not recommended.
## Dose Adjustments
* **Hepatic Impairment:** Reduce dose to 200 mg orally twice daily in patients with severe hepatic impairment (Child-Pugh C). No adjustment is required for mild (Child-Pugh A) or moderate (Child-Pugh B) impairment.
* **Renal Impairment:** No dose adjustment is required for mild to moderate impairment. Use caution in severe renal impairment.
* **Toxicity-based Adjustments:** Dose reduction steps are to 300 mg twice daily, then 200 mg twice daily. Discontinue if patients cannot tolerate 200 mg twice daily. Consult the full prescribing information for specific toxicity grading (e.g., pneumonitis, hepatotoxicity).
## Contraindications
There are no specific contraindications listed in the FDA-approved labeling, though caution is required for patients with pre-existing interstitial lung disease or severe hepatic impairment.
## Adverse Effects
* **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite, and malaise.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis (potentially fatal), hepatotoxicity, and photosensitivity reaction.
## Key Drug Interactions
* **Strong CYP3A inhibitors:** May increase capmatinib plasma concentrations. Monitor closely for toxicity.
* **Strong CYP3A inducers:** May decrease capmatinib plasma concentrations. Avoid concomitant use.
* **P-gp and BCRP substrates:** Capmatinib is an inhibitor of P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP). Monitor for increased toxicity when co-administered with sensitive substrates (e.g., digoxin, rosuvastatin).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms (e.g., cough, dyspnea). Withhold if ILD/pneumonitis is suspected; permanently discontinue if confirmed.
* **Hepatic:** Monitor ALT/AST levels at baseline and monthly during treatment.
* **Dermatologic:** Advise patients to use sun protection (clothing, sunscreen) due to photosensitivity risks.
## Clinical Pearls
* **Administration:** Tablets should be swallowed whole; do not break, crush, or chew. Can be taken with or without food.
* **Missed Dose:** If a dose is missed, do not take an extra dose; take the next dose at the regular scheduled time.
* **Efficacy:** Effectiveness is dependent on the identification of the METex14 mutation via an FDA-approved test.
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**Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before prescribing or administering medication.
