Question 1

Does the IMDC score apply to patients receiving immunotherapy?

Accepted Answer

Yes — validated in patients on first-line immunotherapy. In CheckMate 214, nivolumab/ipilimumab benefit was most pronounced in intermediate/poor-risk patients.

Question 2

How does IMDC differ from the MSKCC (Motzer) score?

Accepted Answer

MSKCC uses LDH instead of neutrophils. IMDC replaced MSKCC as the standard due to validation in targeted therapy and immunotherapy eras.

Question 3

Should IMDC be reassessed during treatment?

Accepted Answer

IMDC is for baseline risk stratification. If patients progress after first-line, the baseline score remains prognostic but requires reinterpretation.

Question 4

What is the role of sarcomatoid histology in IMDC?

Accepted Answer

Sarcomatoid features are not in the IMDC score but confer poor prognosis and higher immunotherapy response. These patients are strong candidates for nivolumab/ipilimumab.