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PubMed This is a summary of 13 peer-reviewed journal articles Updated
Oncology · Metastatic Renal Cell Carcinoma

Your Personal Risk Profile: Understanding the IMDC Score

At a Glance

The IMDC score is a specialized tool used to guide treatment decisions for metastatic kidney cancer. By evaluating six specific clinical and blood test factors, it places patients into favorable, intermediate, or poor risk groups to determine the most effective drug combination.

When kidney cancer has spread (metastatic RCC), doctors don’t just look at the cancer cells; they look at how your whole body is reacting to the disease. To do this, they use a tool called the IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) risk model, also known as the Heng score [1].

Important Note: If your cancer is localized (Stages I, II, or III), this scoring system does not apply to you. It is used exclusively to guide systemic therapy choices for metastatic disease.

This score acts as a compass, helping your oncology team navigate the complex world of modern immunotherapy and targeted drugs to find the treatment plan that fits you best [2].

The Six Factors of the IMDC Model

The IMDC model looks at six specific “risk factors.” These are clinical details or lab results that help predict how the cancer might behave [3].

Factor What It Means in Plain Language
Performance Status A measure of your ability to perform daily activities. A score below 80% on the Karnofsky Scale means you may need some help with daily tasks [4][1].
Time to Treatment If the time between your initial diagnosis and the start of systemic (drug) treatment is less than one year [3].
Hemoglobin A measure of red blood cells. If your levels are below the normal range (anemia), it counts as a factor [5].
Calcium If your blood calcium level is higher than normal (hypercalcemia). High calcium can be a sign the tumor is affecting your metabolism [4].
Neutrophils A type of white blood cell. If the count is higher than normal, it may signal increased inflammation caused by the cancer [1].
Platelets Cells that help your blood clot. A higher-than-normal count (thrombocytosis) is another indicator of inflammation [3].

How Your Risk Category Directs Treatment

Your doctor will count how many of these factors you have to place you in one of three groups. This category is a primary factor in choosing your first-line therapy [2][1]:

  • Favorable Risk (0 factors): Patients in this group often have tumors that grow more slowly. Guidelines typically recommend IO/TKI combinations (immunotherapy plus a targeted pill) for this group [6][7].
  • Intermediate Risk (1–2 factors): This is a diverse group. Doctors may recommend either IO/TKI or IO/IO combinations (two different immunotherapies like nivolumab and ipilimumab) [8][9].
  • Poor Risk (3 or more factors): For this group, the cancer is acting more aggressively. The IO/IO or IO/TKI combinations are prioritized because they have been shown to be more effective than older, single-drug treatments in these cases [9][10].

Why We Use IMDC Over Older Models

You might hear about an older system called the MSKCC (Motzer) criteria. While it was ground-breaking, it was developed decades ago when treatments were very different [11].

The IMDC model is now the standard because it was built using data from patients treated with modern therapies, including the targeted drugs used today [12]. It provides a much more accurate prediction of how a patient will respond to the current “toolbox” of kidney cancer medicines [13][2].

Knowing your IMDC category helps you and your doctor have a more informed conversation about the goals of your treatment and what you can expect in the months ahead.

Common questions in this guide

What is the IMDC score for kidney cancer?
The IMDC score, also known as the Heng score, is a tool doctors use to evaluate how metastatic kidney cancer is affecting your entire body. It helps your oncology team determine the best systemic treatment plan for your specific disease.
Who needs an IMDC score?
This scoring system is exclusively used for patients with metastatic kidney cancer, meaning the disease has spread to other parts of the body. It does not apply to localized kidney cancer in Stages I, II, or III.
What are the six IMDC risk factors?
The model evaluates six factors: your physical ability to perform daily tasks, the time from your initial diagnosis to starting drug treatment, and four specific blood test results (hemoglobin, calcium, neutrophils, and platelets).
What does a favorable risk IMDC score mean?
A favorable risk score means you have zero of the six IMDC risk factors, which usually indicates a slower-growing tumor. For this group, guidelines typically recommend a combination of immunotherapy and a targeted pill.
Why is the IMDC score used instead of the MSKCC criteria?
The IMDC model is the modern standard because it is based on data from patients treated with current immunotherapies and targeted drugs. The older MSKCC or Motzer criteria were developed before these newer treatments existed.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my IMDC risk category: Favorable, Intermediate, or Poor?
  2. 2.Which of the six IMDC factors did I meet to reach that score?
  3. 3.Given my risk score, why are you recommending an IO/TKI combination over an IO/IO combination (or vice versa)?
  4. 4.How will my risk category change the way we monitor my response to treatment?
  5. 5.Is my performance status (KPS) being factored into this score, and how do you evaluate that?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (13)
  1. 1

    Risk Stratification and Treatment Algorithm of Metastatic Renal Cell Carcinoma.

    Grimm MO, Leucht K, Foller S

    Journal of clinical medicine 2021; (10(22)) doi:10.3390/jcm10225339.

    PMID: 34830621
  2. 2

    An Update on Predictive Biomarkers in Metastatic Renal Cell Carcinoma.

    Dudani S, Savard MF, Heng DYC

    European urology focus 2020; (6(1)):34-36 doi:10.1016/j.euf.2019.04.004.

    PMID: 31010693
  3. 3

    Therapy Management Using Modified 2-Weeks-On/1-Week-Off Dosing Schedule in Patients With Metastatic Renal Cell Carcinoma Receiving Sunitinib: A Hypothetical, Illustrative Case Scenario.

    Allman KD, Ryan JC, Clair A, Yenser-Wood S

    Journal of the advanced practitioner in oncology 2019; (10(5)):483-493 doi:10.6004/jadpro.2019.10.5.6.

    PMID: 33457061
  4. 4

    Evolving biological associations of upfront cytoreductive nephrectomy in metastatic renal cell carcinoma.

    Silagy AW, Kotecha RR, Weng S, et al.

    Cancer 2021; (127(21)):3946-3956 doi:10.1002/cncr.33790.

    PMID: 34286865
  5. 5

    Prognostic significance of hemoglobin-to-red cell distribution width ratio in patients with metastatic renal cancer.

    Yılmaz H, Yılmaz A, Demirağ G

    Future oncology (London, England) 2021; (17(29)):3853-3864 doi:10.2217/fon-2021-0040.

    PMID: 34382414
  6. 6

    Choosing the optimal therapy for metastatic renal cell carcinoma: Insights from a real-world comparative study.

    Hara T, Teishima J, Okamura Y, et al.

    International journal of urology : official journal of the Japanese Urological Association 2025; (32(1)):29-38 doi:10.1111/iju.15590.

    PMID: 39400404
  7. 7

    Approaches to First-Line Therapy for Metastatic Clear Cell Renal Cell Carcinoma.

    Chen YW, Rini BI

    Current oncology reports 2022; (24(6)):695-702 doi:10.1007/s11912-022-01196-1.

    PMID: 35247142
  8. 8

    Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma.

    Motzer RJ, Tannir NM, McDermott DF, et al.

    The New England journal of medicine 2018; (378(14)):1277-1290 doi:10.1056/NEJMoa1712126.

    PMID: 29562145
  9. 9

    New First Line Treatment Options of Clear Cell Renal Cell Cancer Patients with PD-1 or PD-L1 Immune-Checkpoint Inhibitor-Based Combination Therapies.

    Grimm MO, Leucht K, Grünwald V, Foller S

    Journal of clinical medicine 2020; (9(2)) doi:10.3390/jcm9020565.

    PMID: 32092974
  10. 10

    Comparative effectiveness of first-line immune checkpoint inhibitors plus tyrosine kinase inhibitors according to IMDC risk groups in metastatic renal cell carcinoma: a meta-analysis.

    Rizzo A, Mollica V, Santoni M, et al.

    Immunotherapy 2021; (13(9)):783-793 doi:10.2217/imt-2021-0005.

    PMID: 33906376
  11. 11

    Contemporary Treatment of Metastatic Renal Cell Carcinoma.

    Stukalin I, Alimohamed N, Heng DY

    Oncology reviews 2016; (10(1)):295 doi:10.4081/oncol.2016.295.

    PMID: 27471582
  12. 12

    Real-world outcomes in patients with metastatic renal cell carcinoma according to risk factors: the STAR-TOR registry.

    Strauss A, Schmid M, Rink M, et al.

    Future oncology (London, England) 2021; (17(18)):2325-2338 doi:10.2217/fon-2020-1020.

    PMID: 33724867
  13. 13

    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 JJ, Xie W, Kroeger N, et al.

    The Lancet. Oncology 2015; (16(3)):293-300.

    PMID: 25681967

This page explains the IMDC risk model for educational purposes only. Always consult your oncologist to understand your specific risk category and treatment plan.

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