International mRCC database consortium

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Int'l mRCC Database Consortium. Prognostic Factors. Anemia. Hypercalcemia. Neutrophilia. Thrombocytosis. KPS < 80%. D
Prognostic Factors for mRCC: Relevance in Clinical Practice Daniel Heng MD MPH FRCPC Chair, GU Tumor Group Tom Baker Cancer Center University of Calgary

Prognostic Factors Patient Factors

Patient X

Performance Status Symptoms Patient Y Tumor Burden Prior nephrectomy Sites of metastases Bone / Liver Metastases LDH Anemia Calcium Sodium

Proinflammatory Markers IL-6 ESR Neutrophilia Thrombocytosis C-reactive protein

Treatment-related Factors Patient Z Prior therapy Prior radiotherapy Disease-free interval Diagnosis to treatment interval

MSKCC Prognostic Profiles

Motzer et al JCO 2002

IKCWG Prognostic Criteria

Manola et al Clin Cancer Res 2011

International mRCC Database Consortium Currently includes 3700 patients from 25 institutions

Int’l mRCC Database Consortium Prognostic Factors

KPS < 80% Dx to Tx Interval 1 year?



Important for clinical trial risk stratification and retrospective study adjustment methods

Italian Database   





281/2065 had 3 lines of targeted therapy VEGF VEGF mTOR vs VEGF mTOR VEGF HR 2.59 (1.59-4.22) after adjusting for prognostic criteria Assumes patients make it to three lines of therapy No axitinib in study Iacovelli et al EJC 2013

Prognostic Factors 

Important for planning therapy  We use temsirolimus for poor risk patients  Is active surveillance appropriate for small

bulk, not growing, favorable risk, highly selected patients  Is cytoreductive nephrectomy appropriate?

Cytoreductive Nephrectomy 3245 mRCC patients

2569 (79%) patients with nephrectomy

676/1658 (41%) No nephrectomy

982/1658 (59%) Cytoreductive Nephrectomy

FINAL NUMBERS

EXCLUDED 1587 (49%) w/ nephrectomy prior to metastases

Overall Survival

Overall Survival Median OS 20.6 vs 9.5 months (p