The 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

Jenny J. Ko, Wanling Xie, Nils Kroeger, Jae lyun Lee, Brian I. Rini, Jennifer J. Knox, Georg A. Bjarnason, Sandy Srinivas, Sumanta K. Pal, Takeshi Yuasa, Martin Smoragiewicz, Frede Donskov, Ravindran Kanesvaran, Lori Wood, D. Scott Ernst, Neeraj Agarwal, Ulka N. Vaishampayan, SunYoung Rha, Toni K. Choueiri, Daniel Y.C. Heng

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Abstract

Background: Previous prognostic models for second-line systemic therapy in patients with metastatic renal cell carcinoma have not been studied in the setting of targeted therapy. We sought to validate the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model in patients with metastatic renal cell carcinoma receiving next-line targeted therapy after progression on first-line targeted therapy. Methods: In this population-based study, we analysed patients who received second-line targeted therapy for metastatic renal cell carcinoma at 19 centres in Canada, USA, Greece, Japan, Singapore, South Korea, and Denmark. The primary endpoint was overall survival since the initiation of second-line therapy. We compared the prognostic performance of the IMDC model with the three-factor MSKCC model used for previously treated patients for overall survival since the start of second-line targeted therapy. Findings: Between Jan 1, 2005, and Nov 30, 2012, we included 1021 patients treated with second-line targeted therapy. Median overall survival since the start of second-line targeted therapy was 12·5 months (95% CI 11·3-14·3). Five of six predefined factors in the IMDC model (anaemia, thrombocytosis, neutrophilia, Karnofsky performance status [KPS] <80, and <1 year from diagnosis to first-line targeted therapy) were independent predictors of poor overall survival on multivariable analysis. The concordance index using all six prognostic factors (ie, also including hypercalcaemia) was 0·70 (95% CI 0·67-0·72) with the IMDC model and was 0·66 (95% CI 0·64-0·68) with the three-factor MSKCC model. When patients were divided into three risk categories using IMDC criteria, median overall survival was 35·3 months (95% CI 28·3-47·8) in the favourable risk group (n=76), 16·6 months (14·9-17·9) in the intermediate risk group (n=529), and 5·4 months (4·7-6·8) in the poor risk group (n=261). Interpretation: The IMDC prognostic model can be applied to patients previously treated with targeted therapy, in addition to previously validated populations in first-line targeted therapy. The IMDC prognostic model in the second-line targeted therapy setting has an improved prognostic performance and is applicable to a more contemporary patient cohort than that of the three-factor MSKCC model. Funding: DF/HCC Kidney Cancer SPORE P50 CA101942-01, Kidney Cancer Research Network of Canada, Canadian Institute for Health Research, Trust Family, Loker Pinard, Michael Brigham, and Gerald DeWulf.

Original languageEnglish
Pages (from-to)293-300
Number of pages8
JournalThe Lancet Oncology
Volume16
Issue number3
DOIs
Publication statusPublished - 2015 Mar 1

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Renal Cell Carcinoma
Databases
Population
Therapeutics
Survival
Kidney Neoplasms
Canada
Karnofsky Performance Status
Thrombocytosis
Republic of Korea
Greece
Singapore
Hypercalcemia
Denmark
Anemia
Japan

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Ko, Jenny J. ; Xie, Wanling ; Kroeger, Nils ; Lee, Jae lyun ; Rini, Brian I. ; Knox, Jennifer J. ; Bjarnason, Georg A. ; Srinivas, Sandy ; Pal, Sumanta K. ; Yuasa, Takeshi ; Smoragiewicz, Martin ; Donskov, Frede ; Kanesvaran, Ravindran ; Wood, Lori ; Ernst, D. Scott ; Agarwal, Neeraj ; Vaishampayan, Ulka N. ; Rha, SunYoung ; Choueiri, Toni K. ; Heng, Daniel Y.C. / The 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. In: The Lancet Oncology. 2015 ; Vol. 16, No. 3. pp. 293-300.
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title = "The 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",
abstract = "Background: Previous prognostic models for second-line systemic therapy in patients with metastatic renal cell carcinoma have not been studied in the setting of targeted therapy. We sought to validate the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model in patients with metastatic renal cell carcinoma receiving next-line targeted therapy after progression on first-line targeted therapy. Methods: In this population-based study, we analysed patients who received second-line targeted therapy for metastatic renal cell carcinoma at 19 centres in Canada, USA, Greece, Japan, Singapore, South Korea, and Denmark. The primary endpoint was overall survival since the initiation of second-line therapy. We compared the prognostic performance of the IMDC model with the three-factor MSKCC model used for previously treated patients for overall survival since the start of second-line targeted therapy. Findings: Between Jan 1, 2005, and Nov 30, 2012, we included 1021 patients treated with second-line targeted therapy. Median overall survival since the start of second-line targeted therapy was 12·5 months (95{\%} CI 11·3-14·3). Five of six predefined factors in the IMDC model (anaemia, thrombocytosis, neutrophilia, Karnofsky performance status [KPS] <80, and <1 year from diagnosis to first-line targeted therapy) were independent predictors of poor overall survival on multivariable analysis. The concordance index using all six prognostic factors (ie, also including hypercalcaemia) was 0·70 (95{\%} CI 0·67-0·72) with the IMDC model and was 0·66 (95{\%} CI 0·64-0·68) with the three-factor MSKCC model. When patients were divided into three risk categories using IMDC criteria, median overall survival was 35·3 months (95{\%} CI 28·3-47·8) in the favourable risk group (n=76), 16·6 months (14·9-17·9) in the intermediate risk group (n=529), and 5·4 months (4·7-6·8) in the poor risk group (n=261). Interpretation: The IMDC prognostic model can be applied to patients previously treated with targeted therapy, in addition to previously validated populations in first-line targeted therapy. The IMDC prognostic model in the second-line targeted therapy setting has an improved prognostic performance and is applicable to a more contemporary patient cohort than that of the three-factor MSKCC model. Funding: DF/HCC Kidney Cancer SPORE P50 CA101942-01, Kidney Cancer Research Network of Canada, Canadian Institute for Health Research, Trust Family, Loker Pinard, Michael Brigham, and Gerald DeWulf.",
author = "Ko, {Jenny J.} and Wanling Xie and Nils Kroeger and Lee, {Jae lyun} and Rini, {Brian I.} and Knox, {Jennifer J.} and Bjarnason, {Georg A.} and Sandy Srinivas and Pal, {Sumanta K.} and Takeshi Yuasa and Martin Smoragiewicz and Frede Donskov and Ravindran Kanesvaran and Lori Wood and Ernst, {D. Scott} and Neeraj Agarwal and Vaishampayan, {Ulka N.} and SunYoung Rha and Choueiri, {Toni K.} and Heng, {Daniel Y.C.}",
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language = "English",
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Ko, JJ, Xie, W, Kroeger, N, Lee, JL, Rini, BI, Knox, JJ, Bjarnason, GA, Srinivas, S, Pal, SK, Yuasa, T, Smoragiewicz, M, Donskov, F, Kanesvaran, R, Wood, L, Ernst, DS, Agarwal, N, Vaishampayan, UN, Rha, S, Choueiri, TK & Heng, DYC 2015, 'The 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', The Lancet Oncology, vol. 16, no. 3, pp. 293-300. https://doi.org/10.1016/S1470-2045(14)71222-7

The 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. / Ko, Jenny J.; Xie, Wanling; Kroeger, Nils; Lee, Jae lyun; Rini, Brian I.; Knox, Jennifer J.; Bjarnason, Georg A.; Srinivas, Sandy; Pal, Sumanta K.; Yuasa, Takeshi; Smoragiewicz, Martin; Donskov, Frede; Kanesvaran, Ravindran; Wood, Lori; Ernst, D. Scott; Agarwal, Neeraj; Vaishampayan, Ulka N.; Rha, SunYoung; Choueiri, Toni K.; Heng, Daniel Y.C.

In: The Lancet Oncology, Vol. 16, No. 3, 01.03.2015, p. 293-300.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The 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

T2 - A population-based study

AU - Ko, Jenny J.

AU - Xie, Wanling

AU - Kroeger, Nils

AU - Lee, Jae lyun

AU - Rini, Brian I.

AU - Knox, Jennifer J.

AU - Bjarnason, Georg A.

AU - Srinivas, Sandy

AU - Pal, Sumanta K.

AU - Yuasa, Takeshi

AU - Smoragiewicz, Martin

AU - Donskov, Frede

AU - Kanesvaran, Ravindran

AU - Wood, Lori

AU - Ernst, D. Scott

AU - Agarwal, Neeraj

AU - Vaishampayan, Ulka N.

AU - Rha, SunYoung

AU - Choueiri, Toni K.

AU - Heng, Daniel Y.C.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background: Previous prognostic models for second-line systemic therapy in patients with metastatic renal cell carcinoma have not been studied in the setting of targeted therapy. We sought to validate the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model in patients with metastatic renal cell carcinoma receiving next-line targeted therapy after progression on first-line targeted therapy. Methods: In this population-based study, we analysed patients who received second-line targeted therapy for metastatic renal cell carcinoma at 19 centres in Canada, USA, Greece, Japan, Singapore, South Korea, and Denmark. The primary endpoint was overall survival since the initiation of second-line therapy. We compared the prognostic performance of the IMDC model with the three-factor MSKCC model used for previously treated patients for overall survival since the start of second-line targeted therapy. Findings: Between Jan 1, 2005, and Nov 30, 2012, we included 1021 patients treated with second-line targeted therapy. Median overall survival since the start of second-line targeted therapy was 12·5 months (95% CI 11·3-14·3). Five of six predefined factors in the IMDC model (anaemia, thrombocytosis, neutrophilia, Karnofsky performance status [KPS] <80, and <1 year from diagnosis to first-line targeted therapy) were independent predictors of poor overall survival on multivariable analysis. The concordance index using all six prognostic factors (ie, also including hypercalcaemia) was 0·70 (95% CI 0·67-0·72) with the IMDC model and was 0·66 (95% CI 0·64-0·68) with the three-factor MSKCC model. When patients were divided into three risk categories using IMDC criteria, median overall survival was 35·3 months (95% CI 28·3-47·8) in the favourable risk group (n=76), 16·6 months (14·9-17·9) in the intermediate risk group (n=529), and 5·4 months (4·7-6·8) in the poor risk group (n=261). Interpretation: The IMDC prognostic model can be applied to patients previously treated with targeted therapy, in addition to previously validated populations in first-line targeted therapy. The IMDC prognostic model in the second-line targeted therapy setting has an improved prognostic performance and is applicable to a more contemporary patient cohort than that of the three-factor MSKCC model. Funding: DF/HCC Kidney Cancer SPORE P50 CA101942-01, Kidney Cancer Research Network of Canada, Canadian Institute for Health Research, Trust Family, Loker Pinard, Michael Brigham, and Gerald DeWulf.

AB - Background: Previous prognostic models for second-line systemic therapy in patients with metastatic renal cell carcinoma have not been studied in the setting of targeted therapy. We sought to validate the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model in patients with metastatic renal cell carcinoma receiving next-line targeted therapy after progression on first-line targeted therapy. Methods: In this population-based study, we analysed patients who received second-line targeted therapy for metastatic renal cell carcinoma at 19 centres in Canada, USA, Greece, Japan, Singapore, South Korea, and Denmark. The primary endpoint was overall survival since the initiation of second-line therapy. We compared the prognostic performance of the IMDC model with the three-factor MSKCC model used for previously treated patients for overall survival since the start of second-line targeted therapy. Findings: Between Jan 1, 2005, and Nov 30, 2012, we included 1021 patients treated with second-line targeted therapy. Median overall survival since the start of second-line targeted therapy was 12·5 months (95% CI 11·3-14·3). Five of six predefined factors in the IMDC model (anaemia, thrombocytosis, neutrophilia, Karnofsky performance status [KPS] <80, and <1 year from diagnosis to first-line targeted therapy) were independent predictors of poor overall survival on multivariable analysis. The concordance index using all six prognostic factors (ie, also including hypercalcaemia) was 0·70 (95% CI 0·67-0·72) with the IMDC model and was 0·66 (95% CI 0·64-0·68) with the three-factor MSKCC model. When patients were divided into three risk categories using IMDC criteria, median overall survival was 35·3 months (95% CI 28·3-47·8) in the favourable risk group (n=76), 16·6 months (14·9-17·9) in the intermediate risk group (n=529), and 5·4 months (4·7-6·8) in the poor risk group (n=261). Interpretation: The IMDC prognostic model can be applied to patients previously treated with targeted therapy, in addition to previously validated populations in first-line targeted therapy. The IMDC prognostic model in the second-line targeted therapy setting has an improved prognostic performance and is applicable to a more contemporary patient cohort than that of the three-factor MSKCC model. Funding: DF/HCC Kidney Cancer SPORE P50 CA101942-01, Kidney Cancer Research Network of Canada, Canadian Institute for Health Research, Trust Family, Loker Pinard, Michael Brigham, and Gerald DeWulf.

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