Category/Class

Targeted therapy; kinase inhibitor 

Mechanism of Action

Tepotinib targets MET variants with exon 14 skipping alterations, inhibiting downstream signaling pathways that promote cell division, the ability to grow and survive dislocated from the tumor, and relocation of MET-dependent cancer cells.  

Indication

Adult patients with metastatic NSCLC with MET exon 14 skipping variants present. 

Dosing and Administration

Administer 450 mg orally once a day with food at relatively the same time each day until patients experience intolerable toxicity or disease progression. Do not chew, crush, or split the pills. Take any missed doses until eight hours before the next dose; at which point, skip the missed dose and take the next dose at the regular time.  

Adverse Reactions

Common adverse reactions (≥ 20%) were edema, fatigue, nausea, diarrhea, musculoskeletal pain, and dyspnea. Grade 3–4 abnormal lab values occurred in ≥ 2% of patients, including decreased lymphocytes, albumin, sodium, and hemoglobin and increased gamma-glutamyltransferase, amylase, ALT, and AST. 

Nursing Considerations

Test for the MET biomarker prior to initiating therapy. Confirm pregnancy status in patients of reproductive potential prior to starting therapy. Monitor liver function levels prior to treatment initiation, every two weeks for the first three months, and then once a month or as needed while on treatment. Educate patients on the risk of embryo-fetal toxicity and recommended use of effective contraception during treatment and for one week after the final dose. Monitor patients for pulmonary symptoms indicative of pneumonitis or interstitial lung disease (ILD). Dose modifications are recommended for any-grade pneumonitis or ILD, grade 3 or 4 increased liver enzymes, and any other grade 3 or 4 adverse reaction.  

Complete a medication review. Tepotinib is a P-gp inhibitor and should not be administered with P-gp substrates because minimal concentration changes could lead to serious or life-threatening toxicities. Strong CYP3A inhibitors and P-gp inhibitors may increase exposure to tepotinib. Strong CYP3A inducers may reduce tepotinib’s effects. 

Patient Education

Teach patients about the side-effect profile and when to notify the healthcare team, including signs and symptoms of worsening respiratory symptoms like trouble breathing, shortness of breath, cough, or fever. Inform patients of frequency of liver function test monitoring. Advise pregnant patients of possible risk to a fetus and recommend that patients or patients’ partners of reproductive potential use contraception during treatment and one week following the last dose. Instruct on proper dosing and administration for oral adherence. 

Gero-Oncology Considerations

No clinically significant differences were found in safety or effectiveness between younger patients and those aged 65 or older. 

Safe Handling

Carcinogenicity studies have not been performed. Tepotinib has been found to cause fetal harm.  

Patient Assistance

Check the Oncology Navigation Center (https://www.oncnavigationcenter.com/en/home.html) or call 844-662-3631.