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    Patent Pending

    IMDC (International Metastatic RCC Database Consortium) Risk Model for Metastatic Renal Cell Carcinoma

    Predicts survival in patients with metastatic renal cell carcinoma treated with systemic therapy.
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    INSTRUCTIONS

    • Use baseline factors at the start date of the current line of systemic therapy, except for the “time of diagnosis to systemic therapy” criterion, which is always relative to first-line therapy.

    • Use limits of normal set by the laboratory performing the tests (for hemoglobin concentration, absolute neutrophil count, platelet count, corrected calcium concentration).

    • Always correct calcium concentration for low albumin before scoring.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with metastatic renal cell carcinoma.

    • Validated in the following settings:

      • Patients with clear cell and non-clear cell metastatic renal cell carcinoma.

      • Patients undergoing targeted therapies and immune checkpoint inhibitor therapy.

      • Multiple care settings: clinical trial patients, patients receiving standard of care therapy at community and academic centers, and across multiple countries.

    • Can assist in the choice of systemic therapy.

    • Easy to use, uses readily available clinical and laboratory variables, and compares favorably to other similar prognosis prediction models.

    Assists clinicians in discussions about prognosis and in deciding the appropriate systemic therapy for patients with metastatic renal cell carcinoma.

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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    According to NCCN guidelines (v3.2019), choice of first-line systemic therapy for metastatic renal cell carcinoma based on risk group is:

    • Intermediate or poor risk: cabozantinib or nivolumab + ipilimumab.

    • Favorable risk: pazopanib or sunitinib.

    Critical Actions

    Can only be applied to patients with metastatic renal cell carcinoma that receive systemic therapy.

    Formula

    Addition of the selected points:

    Variable

    Points

    <1 year from time of diagnosis to systemic therapy

    1

    Karnofsky performance status <80%

    1

    Hemoglobin < lower limit of normal (usually ~120 g/L or 12 g/dL)

    1

    Corrected calcium > upper limit of normal (usually ~8.5-10.2 mg/dL)

    1

    Neutrophils > upper limit of normal (usually ~2.0-7.0×10⁹/L)

    1

    Platelets > upper limit of normal (usually ~150,000-400,000 cells/µL)

    1

    Facts & Figures

    Interpretation:

    IMDC Risk Score

    Risk group Median survival

    0

    Favorable 43.2 months

    1-2

    Intermediate 22.5 months

    ≥3

    Poor 7.8 months

    From Heng 2013.

    Evidence Appraisal

    The International Metastatic RCC Database Consortium (IMDC) risk model was initially derived from a 2009 study of 645 patients with metastatic renal cell carcinoma treated with first-line targeted therapy in 3 US and 4 Canadian centers (Heng 2009). The model showed a concordance index (C-index) of 0.73 and patients classified into the different risk groups had significantly different overall survival.

    The model was subsequently externally validated (Heng 2013) in 849 consecutive patients with metastatic renal cell carcinoma from 13 international cancer centres and was shown to compare favorably to 4 other risk models used in this setting: Memorial Sloan Kettering Cancer Center (MSKCC) model, Cleveland Clinic Foundation (CCF) model, French model, and International Kidney Cancer Working Group (IKCWG) model.

    The model has also been validated in patients with non-clear cell renal cell carcinoma (Kroeger 2013), subsequent lines of therapy (Ko 2015, Wells 2017), and patients treated by immune checkpoint inhibitors (Yip 2017).

    Specific IMDC risk groups have also been shown to have better outcomes with certain systemic therapies. In particular, the IMDC intermediate and poor risk groups should be preferentially treated with first line nivolumab + ipilimumab or cabozantinib therapy (Motzer 2018, Choueiri 2017, NCCN guidelines v3.2019). Thus, IMDC risk groups have also become a tool for the selection of systemic therapy for first line clear cell metastatic renal cell carcinoma patients.

    Literature

    Dr. Daniel Heng

    About the Creator

    Daniel Heng, MD, MPH, is a staff medical oncologist at the Tom Baker Cancer Center in Calgary, Alberta, and a clinical professor of medicine at the University of Calgary. He holds a masters of public health from Harvard University and has a keen interest in outcomes, prognostic factors, and clinical trials research in kidney, bladder, prostate and testicular cancers. He is the chair of the Southern Alberta Genitourinary Tumor Group.

    To view Dr. Daniel Heng's publications, visit PubMed

    Wanling Xie

    About the Creator

    Wanling Xie, MS, is a biostatistician at the Dana-Farber Cancer Institute in Boston, Massachusetts. She has published and co-published dozens of peer-reviewed studies. Dr. Xie's research is mainly focused on genitourinary cancers, particularly metastatic renal cell carcinoma and prostate cancer.

    To view Wanling Xie's publications, visit PubMed

    Dr. Toni Choueiri

    About the Creator

    Toni Choueiri, MD, is a medical oncologist and the director of the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute/Brigham and Women’s Hospital in Boston, Massachusetts. He is also co-leader of the Kidney Cancer Program at Dana-Farber/Harvard Cancer Center and the Jerome and Nancy Kohlberg Professor of Medicine at Harvard Medical School. Dr. Choueiri's research interests include novel therapies and biomarkers in genitourinary malignancies.

    To view Dr. Toni Choueiri's publications, visit PubMed

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