IMDC (International Metastatic RCC Database Consortium) intermediate or poor risk score i...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-RCC-IMDC-INTERMEDIATE-POOR-RISK`
Type	Red flag
Status	reviewed 2026-04-29 \| pending_clinical_signoff
Diseases	`DIS-RCC`
Sources	`SRC-ESMO-RCC-2024` `SRC-NCCN-KIDNEY-2025`

Red Flag Origin

Definition	IMDC (International Metastatic RCC Database Consortium) intermediate or poor risk score in metastatic clear-cell RCC (Heng JCO 2009). Six adverse factors: KPS <80%, time from diagnosis to systemic therapy <1 year, hemoglobin < lower-limit-of-normal (≈12 g/dL), corrected calcium > ULN, neutrophils > ULN, platelets > ULN. 0 factors = favorable; 1-2 = intermediate; ≥3 = poor. CheckMate-214 (Motzer NEJM 2018) established superiority of nivolumab + ipilimumab over sunitinib for intermediate and poor-risk subgroups (mOS 47 vs 26 mo, ITT). KEYNOTE-426 (pembro+axi) benefits across all risk groups; nivo+ipi preferred in int/poor by long-term durable-response signal. Routes ALGO-RCC-METASTATIC-1L step 1 to IND-RCC-METASTATIC-1L-NIVO-IPI; favorable risk falls through to default IND-RCC-METASTATIC-1L-PEMBRO-AXI.
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-RCC-METASTATIC-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "imdc_risk",
      "value": "intermediate"
    },
    {
      "finding": "imdc_risk",
      "value": "poor"
    },
    {
      "finding": "imdc_risk",
      "value": "int"
    },
    {
      "finding": "imdc_risk_score",
      "value": "intermediate"
    },
    {
      "finding": "imdc_risk_score",
      "value": "poor"
    },
    {
      "finding": "imdc_risk_score",
      "value": "int"
    },
    {
      "comparator": ">=",
      "finding": "imdc_risk_factors_count",
      "threshold": 1
    }
  ],
  "type": "risk_score"
}

Notes

Trigger fires on the categorical `imdc_risk` field (favorable / intermediate / poor) when present, or as a fall-back on `imdc_risk_factors_count >= 1` (any IMDC adverse factor). Aggregate computation from raw inputs (KPS, hemoglobin, calcium, neutrophils, platelets, time-to-tx) is left to upstream questionnaire scoring; this RF consumes the already-derived risk category. Conflict-resolution: if RF-RCC-FRAILTY-AGE fires alongside (de-escalate), frailty wins by direction-precedence (de-escalate > intensify? — note: actually intensify > de-escalate in current matrix, so this RF would dominate; reviewers may prefer to add explicit frail-disqualifies-IO logic at algorithm level rather than reordering severity matrix). Brief authoring for W5c chunk 2026-04-30; engine smoke covered by patient_rcc_imdc_int_nivo_ipi.json (intermediate, expects nivo+ipi) and patient_rcc_imdc_fav_axi_pembro.json (favorable, expects pembro+axi).

Used By

Algorithms

ALGO-RCC-METASTATIC-1L - ALGO-RCC-METASTATIC-1L