Tepotinib Therapy for Advanced MET Exon 14 Skipping NSCLC With Non-Dialysis End-Stage Renal Disease: A Case Report.

Tepotinib is an oral mesenchymal-epithelial transition factor (MET) tyrosine kinase inhibitor approved for advanced or metastatic MET exon 14 skipping non-small cell lung cancer (NSCLC). While no dose adjustment is required in patients with mild-to-moderate renal impairment, evidence in those with severe renal dysfunction remains limited. We report a case of advanced MET exon 14 skipping NSCLC in a patient with end-stage renal disease (ESRD) without dialysis who was successfully treated with tepotinib. During therapy, serum creatinine increased, whereas serum cystatin C remained stable, suggesting pseudo-acute kidney injury due to inhibition of renal tubular transporters. Tepotinib was resumed at a reduced dose without further renal deterioration, resulting in a partial tumour response. This case highlights the feasibility of tepotinib therapy in carefully selected patients with ESRD and underscores the clinical utility of incorporating complementary renal biomarkers, cystatin C, for guiding treatment decisions and avoiding unnecessary treatment discontinuation.