On May 6, 2020, the U.S. Food and Drug Administration (FDA) granted accelerated approval to capmatinib (Tabrecta) for 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.
The FDA also approved the FoundationOne CDx assay as a companion diagnostic for capmatinib.
Efficacy was demonstrated in the GEOMETRY mono-1 trial, a multicenter, nonrandomized, open-label, multicohort study enrolling 97 patients with metastatic NSCLC with confirmed MET exon 14 skipping. Patients received capmatinib at 400 mg orally twice daily until disease progression or unacceptable toxicity. The main efficacy outcome measures were overall response rate determined by a blinded independent review committee using Response Evaluation Criteria in Solid Tumors, version 1.1, and response duration.
Among the 28 treatment-naive patients, the overall response rate was 68% (95% confidence interval [CI] = 48%–84%) with a response duration of 12.6 months (95% CI = 5.5–25.3). Among the 69 previously treated patients, the overall response rate was 41% (95% CI = 29%–53%) with a response duration of 9.7 months (95% CI = 5.5–13.0).
The most common adverse reactions (in ≥ 20% of patients) were peripheral edema, nausea, fatigue, vomiting, dyspnea, and decreased appetite. Capmatinib can also cause interstitial lung disease, hepatotoxicity, photosensitivity, and embryofetal toxicity. Based on a clear positive signal for phototoxicity in early laboratory studies in cells, patients may be more sensitive to sunlight and should be advised to take precautions to cover their skin, use sunscreen, and not tan while taking capmatinib.
The recommended capmatinib dose is 400 mg orally twice daily with or without food.