The IMDC criteria is a well-established prognostic tool for patients with mRCC receiving systemic therapy. However, its application in patients receiving Cabozantinib, has not been proven. The aim of this study was to evaluate the predictive markers of the IMDC in mRCC patients receiving Cabozantinib.

A total 56 patients were enrolled from January, 2000 to March, 2025 in China Medical University Hospital. 24 patients received cabozantinib as first line therapy, 11 patients received second line cabozantinib, while 21 patients received cabozantinib as third-line or above therapy. We analyzed treatment response of cabozantinib with IMDC risk model, including less than 1 year from time of diagnosis to systemic therapy, Performance status (ECOG), hemoglobin level (Hb), calcium level (Ca), neutrophil level (Neu) and platelet level(PLT). We demonstrated overall survival (OS), progression-free survival (PFS) in different subgroups using Kaplan-Meier analysis.

In all 56 cases receiving Cabozantinib, the median OS and PFS were 21 months and 9 months, respectively. The IMDC group, ECOG <2, Ca ≤10 mg/dL, Neu ≤7000 × 10⁹/L, and PLT ≤400,000/µL were associated with significantly longer OS, while the IMDC group and ECOG <2 were associated with significantly longer PFS. In the second-line group, the median OS and PFS were 30 months and 9 months, respectively. A PLT level ≤400,000/µL (p=0.002) was associated with significantly longer PFS. In the third-line group, the median OS and PFS were 43 months and 6 months, respectively. The IMDC group (p<0.001), ECOG <2 (p<0.001), and Ca ≤10 mg/dL (p<0.001) were associated with significantly longer OS, while only Ca ≤10 mg/dL (p=0.028) was associated with significantly longer PFS.

According to our analysis, IMDC group and its prognostic factors were associated with treatment response in mRCC patients receiving Cabozantinib, including treatment as as second- or third-line therapy. This real-world study provides evidence of possible prognostic factors in mRCC patients receiving Cabozantinib.