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# Tabrecta (capmatinib)
## Overview
Capmatinib is a selective, ATP-competitive inhibitor of the MET (mesenchymal-epithelial transition) receptor tyrosine kinase. It is an oral antineoplastic agent specifically indicated for tumors harboring MET exon 14 skipping mutations.
## 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 orally twice daily. Continue treatment until disease progression or unacceptable toxicity. Swallow capsules whole; avoid crushing or chewing. May be taken with or without food. If a dose is missed, skip the missed dose unless it is more than 6 hours until the next scheduled dose.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** No adjustment required for mild (Child-Pugh A) impairment. Use is not recommended in moderate (Child-Pugh B) or severe (Child-Pugh C) impairment.
* **Renal Impairment:** No adjustment required for mild or moderate renal impairment (eGFR ≥30 mL/min/1.73m²). Use not established in severe renal impairment or ESRD.
* **Toxicity-based:** If adverse reactions occur, interrupt dose and/or reduce by 100 mg (e.g., 300 mg twice daily, then 200 mg twice daily, then discontinue).
## Contraindications
None established.
## Adverse Effects
* **Common:** Peripheral edema (very common), nausea, fatigue, vomiting, dyspnea, decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis (potentially fatal), hepatotoxicity, photosensitivity, embryo-fetal toxicity.
## Key Drug Interactions
* **Strong CYP3A inhibitors:** May increase capmatinib systemic exposure. Manage by monitoring for increased toxicity.
* **Strong CYP3A inducers:** May decrease capmatinib systemic exposure. Avoid concomitant use; if unavoidable, consider increasing capmatinib dose based on clinical response.
* **Sensitive CYP1A2 substrates:** Capmatinib may inhibit CYP1A2. Use caution if co-administering with narrow therapeutic index 1A2 substrates (e.g., tizanidine, theophylline).
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms (cough, dyspnea, fever) suggestive of ILD/pneumonitis.
* **Hepatic:** Monitor ALT/AST prior to initiation and every 2 weeks during the first 3 months of treatment, then once monthly thereafter.
* **Dermatologic:** Advise patients to use sun protection (sunscreen, protective clothing) due to risk of photosensitivity.
## Clinical Pearls
* Ensure MET mutation status is confirmed via FDA-approved laboratory testing prior to initiation.
* Patients should be advised to report any respiratory symptoms immediately, as early detection of ILD is critical.
* High risk of peripheral edema; consider clinical management (e.g., elevation, diuretics) if symptoms become bothersome.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the latest FDA-approved prescribing information (package insert) and institutional clinical protocols before prescribing or administering any medication. Clinical judgment should be exercised based on individual patient presentation.
