SAN FRANCISCO, CA USA (UroToday.com) - The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) is a database that includes 3 500 patients from 25 institutions from multiple different countries.
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Dr. Daniel Y. C. Heng presented findings from the IMDC, thus far, and future directions for the IMDC. To date the IMDC has provided benchmarks for PFS and OS in the setting of testing new primary, secondary, and tertiary therapeutics in metastatic RCC (mRCC). It has also generated a prognostic model which can be used to classify patients into favorable, intermediate and poor risk groups based on six factors: Karnofsky performance status < 80%, diagnosis to treatment interval less than one year, anemia, thrombocytosis, neutrophilia, and hypercalcemia. He said that this prognostic model has been demonstrated to work in the primary and secondary therapy setting, as well as in the setting of non-clear cell histology. He then reviewed other prognostic factors in mRCC that have been investigated recently including high neutrophil-to-lymphocyte ratio, high CRP, hyponatremia, non-clear cell histology, presence of liver/bone metastases, and sarcomatoid differentiation. The addition of other features to the IMDC factors did not add much to the model and, and the key to improving prognostic ability is in biomarker discovery as opposed to the addition of further clinical data. He finished his discussion on prognosis by stating that its determination should be a dynamic process as it is bound to change over time, particularly as patients survive past the median expected survival of their risk groups.
With regards to improving prediction of response to therapy in mRCC, Dr. Heng stated that no good biomarkers currently exist. Current decisions regarding the sequencing of drugs used are based solely on completed trial data and are not informed at all by tumor biology. He showed data demonstrating that lack of response to a first-line VEGFR TKI did not correlate with a lack of response to a second-line agent, and vice versa. He also stated that the sequence of administration of mTOR inhibitors and VEGFR TKIs does not appear to matter. The use of biomarkers will aid in better predicting which agents should be used in which patients, maximizing the likelihood of tumor response. The IMDC currently is developing a tissue core with the goal of biomarker discovery and validation.
Highlights of a presentation by Daniel Y. C. Heng, MD, MPH at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
The University of Texas Southwestern Medical Center, Dallas, TX USA