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# Tabrecta (capmatinib) ## Overview Tabrecta is a kinase inhibitor that targets the mesenchymal-epithelial transition (MET) receptor. It is an oral antineoplastic agent specifically indicated for tumors harboring MET exon 14 (METex14) skipping 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 as detected by an FDA-approved test. ## Adult Dosing 400 mg (two 200 mg tablets) orally twice daily with or without food. Tablets must be swallowed whole; do not break, crush, or chew. ## Pediatric Dosing Safety and effectiveness in pediatric patients have not been established. There is no supported pediatric dosing information. ## Dose Adjustments **Hepatic Impairment:** No adjustment required for mild (Child-Pugh A) or moderate (Child-Pugh B). Use with caution in severe (Child-Pugh C) impairment. **Renal Impairment:** No adjustment required for mild or moderate renal impairment. **Toxicity Management:** If dose reduction is required due to adverse reactions, reduce to 300 mg twice daily, then to 200 mg twice daily. Discontinue permanently if patients cannot tolerate 200 mg twice daily. ## Contraindications None known. ## Adverse Effects Common adverse reactions (≥20%) include edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite. Significant risks include interstitial lung disease (ILD)/pneumonitis, hepatotoxicity, and photosensitivity. ## Key Drug Interactions * **CYP3A4 Inhibitors:** Strong inhibitors (e.g., ketoconazole) may increase capmatinib concentrations; monitor for increased toxicity. * **CYP3A4 Inducers:** Strong inducers (e.g., rifampin) may decrease capmatinib effectiveness; avoid concomitant use. * **P-gp Substrates:** Capmatinib may increase concentrations of sensitive P-gp substrates (e.g., digoxin). Monitor as appropriate. ## Monitoring * **Pulmonary:** Monitor for new or worsening respiratory symptoms; withhold if suspected ILD/pneumonitis occurs. * **Hepatic:** Check ALT/AST and total bilirubin prior to treatment, every 2 weeks during the first month, then monthly thereafter. * **Skin:** Advise patients to use sun protection (clothing/sunscreen) as photosensitivity reactions can occur. ## Clinical Pearls * If a dose is missed, it should not be taken if it is within 6 hours of the next scheduled dose. * The drug is a substrate of CYP3A4 and P-gp. * Data on safety in pregnancy is limited; it is known to cause fetal harm based on animal models. Use effective contraception during therapy and for at least 1 week after the final dose. *** *Disclaimer: This information is for educational purposes and does not replace professional medical judgment. Always consult the latest FDA-approved prescribing information or institutional clinical protocols before prescribing or administering medications.*