Tepotinib (Tepmetko)

Tepotinib is a type of targeted cancer drug. It is also known as Tepmetko. 

It is a treatment for people with non small cell lung cancer (NSCLC) that has spread to other parts of the body (advanced cancer) and who have previously had treatment for NSCLC. 

You pronounce tepotinib as teh-poh-ti-nib. 

How does tepotinib work?

Tepotinib targets a gene change found in some non small cell lung cancers. This is a change to the mesenchymal-epithelial transition (MET) gene. This change causes the cancer cell to make an abnormal protein. This protein causes cells to grow uncontrollably. 

Tepotinib blocks the abnormal protein which can slow down or stop the cancer from growing. 

To make sure tepotinib is right for you, your doctor tests a sample of your cancer cells to check that you have the MET gene change. 

How do you have tepotinib?

Tepotinib is a tablet. You swallow it whole and must not crush or chew it before swallowing it. You should also take tepotinib with water and with food or shortly after a meal. 

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

How often do you have tepotinib?

You take tepotinib daily at around the same time every day. 

You usually take tepotinib for as long as it is working or until the side effects get too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of tepotinib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Swelling (oedema)

Tepotinib can cause swelling caused by a build up of fluid in your body. The most common areas this can happen are your hands and feet. But you can also have generalised swelling around your body, including your eyes and face and around the genital areas. For example, the vulva, vagina, scrotum, and penis.

Let your nurse or doctor know if you notice any swelling in your body.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Changes to the levels of protein in your blood 

Tepotinib can lower the level of a protein called albumin in your blood. Symptoms include feeling tired and weak, problems with breathing, swelling in your hands and feet, yellow looking skin (jaundice), passing wee more often and yellow coloured wee. You have regular blood tests to check your protein levels. 

You can have high levels of a protein called amylase, but this is less common. Amylase helps you digest carbohydrates. The symptoms are similar to low albumin, but you might also have a fever, a fast heartbeat, pain in your tummy, and smelly poo. 

Diarrhoea 

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Constipation  

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Rarely your liver may stop working properly.

Kidney problems

You can have high levels of creatinine in your blood with tepotinib. Creatinine is a waste product that is removed from the body by the kidneys. Symptoms include loss of appetite, general itching, having a wee more often or less often, and feeling tired.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• lung problems - this includes difficulty breathing, a cough, feeling tired, confusion, feeling faint, and a fever. Call your advice line straight away if you have any of these symptoms 
• increase in an enzyme called lipase - symptoms you might have include feeling or being sick, pain in your back or severe pain in the upper part of your tummy, a fast pulse rate, pale looking poo that has a bad smell, and a fever

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility 

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This drug may harm a baby developing in your womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 1 week after you stop taking tepotinib.

Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment and for at least 1 week after you stop taking tepotinib.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.