E5202 Leucovorin Supplemental Form Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer NCT00217737 Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 3/23/15 3/23/15 - Martin Dugas
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March 23, 2015

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Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00217737

INSTRUCTIONS: Complete this form at the end of each cycle during the Leucovorin shortage.

Please mark an 'X' if data have been amended
Reporting Period (1 cycle = 2 weeks)
Was Leucovorin administered
If (racemic) Leucovorin was not given, please specify why
Was Levoleucovorin substituted

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