IMDC prognostic model valid in second-line RCC therapy

Mar 25 2015

By Shreeya Nanda, Senior medwireNews Reporter

The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model can be applied to metastatic renal cell carcinoma (RCC) patients receiving second-line targeted treatment, according to research published in The Lancet Oncology.

This model is “applicable to a more contemporary patient cohort” than the three-factor Memorial Sloan Kettering Cancer Center (MSKCC) model, “which was studied in a historical cohort who progressed on first-line treatments such as cytokine immunotherapy”, say Daniel Heng, from the University of Calgary in Alberta, Canada, and co-workers.

A total of 1021 patients who received either a vascular endothelial growth factor inhibitor or an anti-mammalian target of rapamycin drug after disease progression on first-line targeted therapy were included in the analysis. This group included 201 patients from the original cohort used to develop the IMDC model.

Of the six predefined factors in the IMDC model, Karnofsky performance status, time from diagnosis to first-line targeted therapy, haemoglobin levels, and neutrophil and platelet counts were significantly and independently associated with overall survival.

The remaining factor, serum calcium concentration, showed a significant correlation with overall survival in the univariate, but not the multivariate analysis, which the researchers think is “probably because of a very small number of patients who had hypercalcaemia (9%)”.

When the study population was stratified using the IMDC model, median overall survival was 35.3, 16.6 and 5.4 months in the favourable (0 risk factors), intermediate (1–2 risk factors) and poor (≥3 risk factors) risk groups, respectively, with a statistically significant difference between the groups.

Comparison of the IMDC and the MSKCC models using the concordance index (C-index; 0.70 for the IMDC and 0.66 for the MSKCC model) and the likelihood ratio test showed that “the IMDC model enhances the prognostic ability of the MSKCC model by its additional three prognostic factors”, report Heng et al.

Noting that the IMDC model is “based on a large multicentre cohort of consecutive patients with metastatic renal cell carcinoma who were treated either on or outside of clinical trials with first-line targeted therapy”, they suggest that it is “likely generalisable to contemporary real-life patients seen in clinic.”

The teams adds, however, that “[t]he IMDC model in the setting of second-line targeted therapy would also be strengthened by additional external validation in patients on previous second-line targeted therapy trials such as TARGET, RECORD-1, AXIS, and INTORSECT.”

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