Guiding Renal Cell Carcinoma Patient Counseling With IMDC Prognostic Factors With David Maj, MBBS, MSc, FRCPC

Understanding IMDC Prognostic Factors

The International Metastatic RCC Database Consortium (IMDC) risk model has long guided treatment decisions in metastatic RCC. “The IMDC risk factors are a mixture of clinical and lab factors—such as time from diagnosis to treatment, performance status, hemoglobin, calcium, platelets, and neutrophils—that help us stratify patients into favorable, intermediate, or poor risk groups,” Dr. Maj explains. “This has implications for long-term survival and eligibility for specific therapies.”

These risk groups, first validated in the vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) era, remain relevant in the current immunotherapy landscape. “It’s important because it helps clinicians get a sense at the start of therapy of what their patient’s prognosis might be and which treatments are most appropriate,” he adds.

Investigating Second-Line Prognosis

While IMDC risk factors are well-established for first-line therapy, Dr. Maj’s team sought to clarify their role in the second-line setting. “We use IMDC risk factors a lot in the first line, but I was interested in whether these still hold true after immunotherapy and what happens if a patient’s risk group changes between lines of therapy,” he says.

Leveraging the IMDC’s robust database of over 10,000 patients, the team conducted a retrospective analysis of 781 patients who received first-line immunotherapy and subsequent second-line treatment. “This gave us a rich dataset to analyze outcomes based on risk group changes,” Dr. Maj notes.

Key Findings and Clinical Implications

The study established new real-world benchmarks for second-line prognosis: “If you’re favorable-risk in the second line, median survival is about 40 months; intermediate-risk, 26 months; and poor-risk, 10 months,” Dr. Maj reports. “That’s useful to know for counseling patients.”

Importantly, the type of first-line immunotherapy did not significantly influence the second-line risk group. “It’s reassuring that we can focus on making the best first-line decision without worrying about negative long-term implications for second-line risk,” he says.

Risk group changes were also notable: about 66% of patients maintained their risk group, 12% improved, and 22% worsened. “Patients who improve from intermediate to favorable risk do better than those who remain intermediate, who in turn do better than those who worsen to poor risk,” Dr. Maj highlights. “So, changes in risk group have real prognostic implications.”

Informing Patient Counseling and Research

For clinicians, these findings underscore the importance of reassessing risk at each treatment stage. “When we meet patients in the second line, it’s important to reset expectations and provide updated prognostic information,” Dr. Maj advises. “This helps with goals of care and planning.”

From a research perspective, the results guide clinical trial design. “It’s crucial to stratify patients by their second-line risk, not just first-line, to avoid confounding results,” he emphasizes.

World Kidney Cancer Day: A Message of Hope

Reflecting on World Kidney Cancer Day, Dr. Maj shares an optimistic outlook: “There have been massive changes in kidney cancer treatment in just the past five or six years, and there’s a lot of hope and excitement in the field. I hope clinicians and patients alike take that away on World Kidney Cancer Day.”

Key Takeaways

• IMDC risk factors remain prognostic in the second-line setting after immunotherapy for metastatic RCC.
• Median survival by risk group in the second line is 40 months (favorable), 26 months (intermediate), and 10 months (poor).
• Most patients maintain their risk group, but changes can have with prognostic implication.
• First-line therapy choice does not significantly impact second-line risk group.
• Reassessing risk at each treatment stage is essential for patient counseling and clinical trial design.
• The kidney cancer field is rapidly evolving, offering new hope for patients worldwide.

About Dr. Maj

David Maj, MBBS, MSc, FRCPC, is a Staff Oncologist at the Arthur Child Cancer Center in Calgary, Alberta, Canada. He specializes in the treatment of genitourinary and breast cancers, and his research focuses on understanding real-world data and mitigating adverse effects of cancer therapies.