The International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Model Could be Applied to Setting of Patients Previously Treated with Targeted Therapy

A study in patients with mRCC treated with second-line targeted therapy

In a study published online on 11 February 2015 in the Lancet Oncology, researchers tried to validate the International Metastatic Renal Cell Carcinoma Database Consortium model in patients with metastatic renal cell carcinoma (mRCC) previously treated with first-line targeted therapy.

In this population-based study, they analysed patients who received second-line targeted therapy for mRCC in Canada, USA, Greece, Japan, Singapore, South Korea, and Denmark. The rationale for the study was that previous prognostic models for second-line systemic therapy in patients with mRCC have not been studied in the setting of targeted therapy. 

The primary endpoint of the study was overall survival (OS) since the initiation of second-line therapy. The researchers compared the prognostic performance of the International Metastatic Renal Cell Carcinoma Database Consortium model with the three-factor Memorial Sloan Kettering Cancer Center model.

From 2005 to 2012, the researchers included 1021 mRCC patients treated with second-line targeted therapy. Median OS since the start of second-line targeted therapy was 12.5 months.

In a multivariable analysis 5 of 6 predefined factors in the International Metastatic Renal Cell Carcinoma Database Consortium model (anaemia, thrombocytosis, neutrophilia, Karnofsky performance status <80, and less than 1 year from diagnosis to first-line targeted therapy) were independent predictors of poor OS. The concordance index using all 6 prognostic factors (including also hypercalcaemia) was 0.70 with the International Metastatic Renal Cell Carcinoma Database Consortium model and 0.66 with the three-factor Memorial Sloan Kettering Cancer Center model.

When patients were divided into three risk categories using International Metastatic Renal Cell Carcinoma Database Consortium criteria, median OS was 35.3 months in the favourable risk group, 16.6 months in the intermediate risk group, and 5.4 months in the poor risk group.

The authors interpreted the study findings with concluding that the International Metastatic Renal Cell Carcinoma Database Consortium prognostic model “has an improved prognostic performance in the second-line targeted therapy setting”. In addition, “it is applicable to a more contemporary patient cohort than that of the three-factor Memorial Sloan Kettering Cancer Center model”.

The study was funded by multiple non-profit funds.

Reference

Ko JJ, Xie W, Kroeger N, et al. T he International Metastatic Renal Cell Carcinoma Database Consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: a population-based study. Lancet Oncology 2015; Published Online 11 February. DOI: http://dx.doi.org/10.1016/S1470-2045(14)71222-7