Tepotinib (Tepmetko)

Medicine at a glance

Tepotinib, also called Tepmetko, is a targeted cancer medicine taken once daily with food. It blocks a growth-signalling protein called MET. Before prescribing it, the team checks for a particular cancer-cell change called MET exon 14 skipping. Having any MET abnormality does not automatically mean this medicine is suitable.

The usual adult starting dose is two 225 mg tablets together each day, although your own prescription may differ. Swelling from fluid build-up is especially common and sometimes troublesome. Important risks include lung inflammation, liver injury and changes in pancreatic enzymes. Blood tests and prompt reporting of symptoms help the team manage these risks.

What tepotinib is and how it works

MET is a protein that helps transmit signals controlling cell growth. With MET exon 14 skipping, part of the gene's instructions is left out when the protein is made. This can allow abnormal growth signalling to continue. Tepotinib is a protein kinase inhibitor: it interferes with MET activity and the signals sent inside the cell.

This is targeted therapy, rather than conventional chemotherapy or an immune-checkpoint medicine. It may shrink or slow a cancer with the relevant MET changes, but responses vary. Scans and clinical reviews remain necessary.

How the team decides whether it is suitable

The oncologist considers your exact diagnosis, molecular test result, previous treatment, general health and applicable prescribing information. A validated test needs to identify an alteration leading to MET exon 14 skipping. A report that mentions MET amplification or another MET finding needs specialist interpretation rather than assuming it means the same thing.

Testing can use tumour tissue or blood containing DNA released by the tumour. The US label recommends blood testing only when a tumour biopsy cannot be obtained. If that blood test does not identify the alteration, the team reassesses whether tissue testing is possible. A negative blood result does not always settle the question.

Tell the team about existing swelling, kidney or liver disease, pancreatitis, lung inflammation, heart-rhythm problems and previous cancer treatments. Mild or moderate kidney or liver impairment does not routinely require an initial dose adjustment in the reviewed labels. Severe impairment has not been adequately studied; European guidance does not recommend treatment in severe kidney or liver impairment. Your team must make an individual assessment. Safety and effectiveness below age 18 have not been established.

Before treatment starts

Bring a list of every medicine and supplement you take, including non-prescription pain relief, herbal remedies, blood thinners, heart medicines and diabetes treatment. Tell the pharmacist about allergies and ingredient intolerance. Do not take it if you have a known allergy to tepotinib or its ingredients. The US coating contains lactose; the European ingredient list does not list it. Check your own pack if this matters to you.

Baseline tests usually include liver enzymes and bilirubin, kidney measurements, blood counts, albumin and relevant salts. Albumin is an important blood protein, and a fall can accompany fluid build-up. The US prescribing information also calls for pancreatic enzymes, amylase and lipase, before treatment and regularly during it. A pregnancy test is needed where relevant.

The team may record your weight, swelling, breathing and activity. If you are at risk of a heart-rhythm change, they may check an electrocardiogram, or ECG, and blood salts. Ask how to monitor swelling at home.

How to take tepotinib

Daily dose and why food matters

A usual adult dose is 450 mg once a day, taken as two 225 mg tablets together. Take it with food at approximately the same time daily; the European patient leaflet also describes taking it shortly after a meal. Food affects how much medicine is absorbed. If poor appetite makes this difficult, ask for help instead of routinely taking it on an empty stomach.

You may see research or older descriptions referring to 500 mg. This reflects the salt form used to make the tablet: each 225 mg of tepotinib corresponds to 250 mg of tepotinib hydrochloride hydrate. Two tablets therefore contain 450 mg of tepotinib, equivalent to 500 mg of that salt. These are two ways of expressing the same amount, not an instruction to add extra medicine. Use the prescribed tablet strength and count.

Swallow tablets whole with water. Do not chew, crush or split them. If side effects require it, the clinician may pause treatment or reduce the dose to one 225 mg tablet daily. Do not make that change yourself or try to achieve it by breaking a tablet.

If tablets are difficult to swallow

The labels provide a water-dispersion method. Ask the pharmacist to demonstrate it. Place your prescribed tablets, without crushing them, in a glass containing 30 mL of still, non-carbonated water. Use no other liquid. Stir until small pieces form; this may take a few minutes, and the tablets will not completely dissolve.

Drink the dispersion promptly and always within one hour of preparation, without chewing the pieces. Add another 30 mL of water to the glass, rinse it thoroughly and drink this immediately so that you receive the remaining medicine. The instruction to take tepotinib with food still applies.

A nasogastric tube method is also supported for tubes at least 8 French in size. It uses the same initial 30 mL dispersion, administered within one hour according to the tube manufacturer's instructions, followed by two separate 30 mL rinses. Ask the oncology pharmacist or trained nurse to organise the method and feeding schedule. Do not assume these instructions apply to every type of feeding tube.

Missed doses, vomiting and extra tablets

If you forget a dose, take it when remembered on the same day unless your next dose is due within eight hours. In that case, skip the missed dose and resume at the usual time. Do not double the next dose. This rule looks forward to the next scheduled dose; it does not mean you can take a missed dose only within eight hours of its original time.

If you vomit after taking tepotinib, do not take a replacement dose. Take the next dose at its normal time. Report repeated vomiting, inability to eat or trouble keeping fluids down. If you accidentally take too many tablets, contact your treating team promptly and tell them the strength, number and timing.

Storage and handling

Keep tablets in their original packaging and out of children's and pets' reach. US instructions specify storage at 20–25°C (68–77°F), with short excursions to 15–30°C (59–86°F) permitted; European information states no special storage conditions. Protect your supply from an overheated car and follow the label on your pack. Return unused medicine through a pharmacy rather than disposing of it in wastewater or household rubbish.

Monitoring and checking whether treatment is working

You need regular blood tests even when you feel well. US instructions specify liver tests before treatment, every two weeks for the first three months, then monthly or as clinically indicated. European information calls for baseline testing and subsequent checks as clinically indicated rather than giving that fixed timetable. Your team will set your actual schedule and test more frequently if results change.

Pancreatic enzymes may rise without symptoms. Current US guidance requires baseline and regular amylase and lipase checks; the exact interval is individual. Blood counts, kidney measurements, albumin and salts also help the team understand fatigue, swelling, dehydration and other symptoms.

The European label advises ECG and electrolyte monitoring as needed in patients at risk of QT prolongation, a change in the heart's electrical recovery time. This includes people with low salts or medicines that can lengthen QT. It does not require every patient to follow an identical ECG schedule.

Scans and clinical reviews show whether the cancer is responding or remaining controlled. Keep a diary of doses, swelling and other symptoms. A pause or dose reduction does not by itself mean the cancer has worsened.

Common side effects and practical management

Swelling and fluid build-up

Oedema means fluid collecting in body tissues. With tepotinib it commonly affects the feet, ankles or legs, but the face, area around the eyes, hands or genital area can also swell. Shoes and rings may feel tight, walking may become uncomfortable and your weight may rise. Report new swelling early, including symptoms that feel embarrassing to discuss.

Raising your legs while sitting may help. Ask the team about movement, suitable clothing and whether compression garments are appropriate after assessing circulation and the cause of swelling. The team may recommend supportive measures, medicines or a treatment pause. Do not borrow water tablets or sharply restrict drinking yourself: dehydration and salt problems can make matters worse.

Swelling can persist and may take time to improve. Do not assume every new swelling is a harmless tablet effect. A suddenly painful, hot or swollen single leg needs urgent assessment for another cause, including a clot. Rapid weight gain with breathlessness also needs urgent review.

Low albumin

Tepotinib can lower albumin, a protein measured in blood tests. Albumin helps maintain normal fluid balance, and a low level may contribute to swelling. It can also reflect several other medical or nutritional factors. A result needs interpretation alongside your overall condition.

Simply buying a protein powder is not a complete treatment for a low albumin result. Tell the team about appetite or weight changes and ask whether a dietitian would help. They will decide whether additional investigations or a treatment adjustment are needed.

Nausea, appetite and bowel changes

Small, frequent meals and prescribed anti-sickness treatment can help nausea. Because tepotinib needs food, seek advice if nausea stops you eating around dose time. Repeated vomiting, increasing abdominal pain or inability to drink deserves prompt contact.

Record diarrhoea compared with your normal bowel pattern and follow the team's anti-diarrhoea plan. Replace lost fluids as advised, using an individual target if you have swelling, heart disease or kidney disease. Dizziness, very little urine, fever, blood in the stool or ongoing watery diarrhoea requires urgent advice.

For constipation, appropriate fluids, gentle activity and a recommended laxative may help. Severe abdominal pain with vomiting or inability to pass stool or wind needs urgent assessment rather than simply adding fibre.

Tiredness, aches and skin symptoms

Fatigue can have several causes, including cancer, treatment, poor sleep, anaemia or changes in blood salts. Balance manageable activity with rest and tell the team if tiredness is new or limiting your daily tasks. New breathlessness should be assessed urgently rather than being put down to tiredness.

Muscle and joint discomfort can occur. Ask which pain medicine is suitable, especially if liver or kidney results have changed. A rash or itch may respond to gentle skin care and prescribed treatment; report it early. Seek urgent help for a rapidly spreading painful rash, blistering, mouth involvement or swelling affecting breathing.

Important risks that need medical assessment

Lung inflammation and other causes of breathlessness

Tepotinib can cause interstitial lung disease or pneumonitis, meaning inflammation within the lungs. This can be serious or fatal. Contact the team immediately for new or worsening shortness of breath, cough or fever. They will look for inflammation and other causes, such as infection, cancer progression or fluid around the lungs.

If lung inflammation is suspected, withhold tepotinib and seek immediate advice before another dose. It is permanently discontinued when confirmed. Do not try to manage new breathlessness at home with leftover antibiotics or steroids. Severe breathing difficulty requires emergency care.

Fluid around the lungs, called a pleural effusion, and pneumonia have also been reported during treatment. These are further reasons why breathlessness needs assessment rather than an assumption that swollen ankles explain it.

Liver injury

Liver enzymes can rise without symptoms, but severe liver injury, including a fatal case in the US safety data, has occurred. Seek immediate advice for yellow eyes or skin, dark urine, pale stools, unusual weakness, appetite loss, nausea, right-sided upper abdominal pain or abdominal swelling. Confusion or marked illness needs emergency assessment.

The team may repeat tests, investigate other causes, pause treatment, reduce the dose or stop it permanently. Do not self-treat with a “liver detox” supplement, which could itself interact with treatment or harm the liver.

Pancreatic enzyme changes and pancreatitis

Amylase and lipase are digestive enzymes used as markers of pancreatic problems. Higher levels do not automatically mean you have pancreatitis, which is inflammation of the pancreas. European study information describes enzyme rises that were asymptomatic and not associated with pancreatitis. Nevertheless, current US prescribing information includes pancreatic toxicity monitoring and specific actions for severe pancreatitis.

Report new upper abdominal pain, particularly if it spreads to your back or worsens after eating, with nausea, vomiting or unexplained weight loss. Severe or persistent pain needs urgent assessment. The team may hold or reduce treatment for enzyme changes and permanently stop it for severe pancreatitis. Do not wait for a scheduled blood test when you have symptoms.

Creatinine and kidney assessment

Creatinine is a waste marker often used to estimate kidney filtering. Tepotinib can interfere with proteins that move creatinine into urine, causing its blood level to rise without the same degree of true kidney damage. This can make a creatinine-based kidney estimate look worse.

That explanation is not a reason to ignore an abnormal result. The European label recommends further assessment to exclude kidney impairment. Dehydration, other medicines and illness can still affect real kidney function. Report markedly reduced urine, blood in urine or worsening illness; your team may use additional tests to interpret the change.

Heart-rhythm changes and infection concerns

QT prolongation has been reported in European safety information, sometimes without symptoms. Report palpitations or sudden dizziness promptly; fainting, collapse or a seizure needs emergency assessment. Keep the team informed about medicines that affect heart rhythm and significant diarrhoea or vomiting that could disturb salts.

Blood counts can fall, and infections such as pneumonia can occur. Contact the team for fever, shaking chills or feeling acutely unwell. Use your hospital's temperature threshold. Seek urgent advice at 37.5°C (99.5°F) or above, below 36°C (96.8°F), or if acutely unwell despite a normal reading.

Other medicines, supplements and vaccines

Tepotinib affects transport proteins that control how some medicines move through the body. It can increase exposure to medicines such as dabigatran, a blood thinner, or digoxin, used for heart problems. US guidance advises avoiding certain sensitive P-glycoprotein substrates where small changes can cause serious toxicity; if unavoidable, the prescriber may adjust the other medicine.

European guidance also advises monitoring medicines such as rosuvastatin, methotrexate and metformin. Tell the team about every new antibiotic, pain medicine, supplement and herbal product before taking it. Do not stop these medicines yourself.

Do not copy interaction instructions from another targeted therapy. Current tepotinib data do not show a clinically important effect from omeprazole when tepotinib is taken with food, and the reviewed labels do not require routine acid-reducer spacing. Older lists may also contain broader enzyme-interaction restrictions than current information. Your pharmacist should review your actual list using the current label.

Ask about vaccination timing. Non-live vaccines may be appropriate, while live vaccines require review of your immune status and all recent treatments. A fixed long vaccine restriction should not be assumed from tepotinib alone.

Everyday life during treatment

Eat regularly and ask for help if you are losing appetite or weight. Fluid advice should be individual because diarrhoea and swelling can occur at the same time. Ask about alcohol in view of the liver risk. Tell your dentist and any other clinician that you take tepotinib before procedures or new prescriptions.

Tepotinib does not have a general driving ban, but do not drive when dizzy, sleepy, breathless or otherwise unsafe. For travel, plan medicine supply, meal timing, blood tests and access to care. Carry tablets in labelled packaging and avoid leaving them in extreme heat.

Sex and intimacy can be affected by fatigue or genital swelling. Tell the team rather than assuming nothing can help. Pregnancy precautions apply even if fertility seems reduced during illness.

Fertility, contraception, pregnancy and breastfeeding

Tepotinib can harm a developing baby. A pregnancy test is recommended before treatment where relevant, and the team should discuss contraception before the first dose. Report a possible pregnancy in you or your partner promptly.

Patients who can become pregnant should use effective contraception during treatment and for at least one week after the last dose. European information additionally advises a barrier method alongside systemically acting hormonal contraception during this period because its reliability with tepotinib is uncertain.

Male patients with a partner who can become pregnant also need contraception during treatment and for at least one week afterwards. European guidance specifies a barrier method; US guidance says effective contraception. Ask the team to explain suitable methods and the date precautions can end.

Do not breastfeed during treatment or for at least one week after the final dose. The effect on human fertility is not established. Discuss preservation before starting if future parenthood matters to you; do not assume normal fertility or permanent infertility from an animal study or the absence of menstrual periods.

After a pause or when treatment finishes

Restart only when your oncology team has confirmed the dose and necessary tests. A pause for swelling or an abnormal result may be part of planned management. Confirm whether you are restarting one or two tablets, and continue taking the prescribed dose with food.

Swelling and low albumin may take time to improve, so keep follow-up appointments rather than expecting immediate recovery. Continue reporting new breathing symptoms after treatment, and complete the contraception and breastfeeding precaution periods. Return unused tablets and clarify when your next scan, blood test or supportive-care review is due.

Frequently asked questions