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# Tabrecta (capmatinib)
## Overview
Capmatinib is a tyrosine kinase inhibitor (TKI) that targets mesenchymal-epithelial transition (MET) exon 14 skipping alterations. It is an oral antineoplastic agent.
## 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.
## Adult Dosing
* **Recommended dose:** 400 mg administered orally twice daily.
* **Administration:** May be taken with or without food. Tablets must be swallowed whole; do not crush, chew, or split.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients. Use is off-label or within clinical trials only.
## Dose Adjustments
* **Hepatic Impairment:** Avoid in patients with severe hepatic impairment. No starting dose adjustment for mild or moderate impairment.
* **Toxicity:** Dose reductions (to 300 mg BID, then 200 mg BID) or discontinuation are required for grade 3 or 4 adverse reactions (e.g., interstitial lung disease/pneumonitis, hepatotoxicity). Refer to full prescribing information for specific toxicity-based reduction schedules.
## Contraindications
No specific absolute contraindications listed in FDA labeling, though hypersensitivity to the drug or excipients should be noted.
## Adverse Effects
* **Common:** Peripheral edema, nausea, fatigue, vomiting, dyspnea, decreased appetite.
* **Serious:** Interstitial lung disease (ILD)/pneumonitis, hepatotoxicity (elevated LFTs), photosensitivity reaction.
## Key Drug Interactions
* **Strong CYP3A4 inhibitors:** May increase capmatinib plasma concentrations; monitor closely for toxicity.
* **Strong CYP3A4 inducers:** May decrease capmatinib efficacy; avoid co-administration.
* **CYP1A2 substrates:** Capmatinib may increase exposure to sensitive CYP1A2 substrates (e.g., tizanidine); avoid co-administration if possible.
## Monitoring
* **Pulmonary:** Monitor for new or worsening respiratory symptoms (potential ILD/pneumonitis).
* **Hepatic:** Monthly liver function tests (ALT/AST/bilirubin) for the first 3 months of treatment.
* **Dermatologic:** Advise patients to use sun protection (sunscreen/clothing) due to photosensitivity risk.
## Clinical Pearls
* Confirm MET exon 14 skipping mutation status using an FDA-approved test prior to initiation.
* If a dose is missed, skip the missed dose and resume the next dose at the scheduled time. Do not take extra doses to make up for a missed one.
* Patients with significant baseline peripheral edema should be monitored closely, as it occurs in over 50% of patients.
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**Disclaimer:** This information is for educational purposes and does not replace professional medical judgment. Always verify current prescribing information, institutional protocols, and FDA-approved labels before prescribing or administering any medication.
