International mRCC Database Consortium

- For use in patients with mRCC for prognostication and treatment selection.

- Select Yes for each risk factor present, then select the setting of interest: first line, second line, third line, fourth line, or first line non-clear-cell. The risk group and corresponding estimated median survival in the TKI era will be displayed at the bottom of the calculator.

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

- Always use albumin-corrected calcium concentration.

- These are population medians only and are not meant to guide or advise individual patients. This should not be interpreted as medical advice or replace the expert opinion of a medical doctor.

The IMDC Criteria were developed as a prognostic tool for patients with mRCC who receive systemic therapy. They have been externally validated in the first-, second-, third-, fourth-line settings, with the use of TKIs and Nivolumab, and with non-clear cell RCCs in the first-line setting. Patients are stratified as follows:

0 factors = Favourable-risk disease

1-2 factors = Intermediate-risk disease

3+ factors = Poor-risk disease

The IMDC criteria are also predictive and aid in therapy selection in the first-line setting. Patients with intermediate- and poor-risk disease derive survival benefit from ipilimumab + nivolumab vs sunitinib while patients with favourable-risk do not (Checkmate 214). Axitinib + pembrolizumab (Keynote 426) and axitinib + avelumab (Javelin 101) may be used across any IMDC risk group. The phase II CABOSUN trial also demonstrated benefit of cabozantinib over sunitinib in intermediate- and poor-risk patients.

1. Heng et al. J Clin Oncol. 2009 Dec 1;27(34):5794-9.

2 Heng et al. Lancet Oncol. 2013 Feb;14(2):141-8.

3. Ko et al. Lancet Oncol. 2015 Mar;16(3):293-300.

4. Wells et al. Eur Urol. 2017 Feb;71(2):204-209.

5. Stukalin et al. Kidney Cancer. 2018 Mar;2(1):31-36.

6. Kroeger et al. Cancer. 2013 Aug 15;119(16):2999-3006.

7. Yip et al. Cancer. 2018 Sep 15;124(18):3677-3683.