# IMDC risk groups (favourable / intermediate / poor)

Source: https://onco.cc/terms/imdc-risk/  
OnCo record `imdc-risk` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The IMDC score uses six factors to sort metastatic kidney cancer into three risk groups. It decides whether dual immunotherapy or immunotherapy plus a targeted pill is offered first.

## Summary

International Metastatic RCC Database Consortium (Heng) criteria: Karnofsky <80%, <1 year from diagnosis to treatment, anaemia, hypercalcaemia, neutrophilia, thrombocytosis. 0 factors favourable, 1-2 intermediate, ≥3 poor. Nivolumab-ipilimumab's OS benefit is confined to intermediate/poor risk; IO-TKI doublets benefit all groups on PFS, with less clear OS benefit in favourable risk.

## Fields

- Kind: Term
- Last checked: 2026-09-07

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Renal_cell_carcinoma
- IMDC (Heng) prognostic model for metastatic RCC (Heng et al., J Clin Oncol 2009): https://doi.org/10.1200/JCO.2008.21.4809

## Connected records

- cancers: [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- trials: [CheckMate 214](https://onco.cc/trials/checkmate-214/), [CLEAR (KEYNOTE-581)](https://onco.cc/trials/clear/), [KEYNOTE-426](https://onco.cc/trials/keynote-426/)
- key papers: [Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study](https://onco.cc/key-papers/paper-heng-j-clin-oncol/)
- pairings: [IMDC risk → first-line regimen choice (RCC)](https://onco.cc/pairings/risk-directed-first-line-rcc/)

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