Description:

CALGB: 40302 FOLLOW-UP FORM NCT00390455 Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5A8CF0A-51C1-3C78-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F5A8CF0A-51C1-3C78-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/8/15
  3. 6/8/15
Uploaded on:

June 8, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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CALGB_40302_FU_FRM NCT00390455

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

CALGB clinical trial administrative data
Are data amended
Vital Status
Patient's vital status (Mark one with an X.)
Primary cause of death (Mark one with an X.)
Has the patient had a documented clinical assessment for this cancer
Was patient restaged during this time period
Overall Response Status at This Assessment (If yes, complete the following questions and submit C-817 Follow-up Solid Tumor Measurement Form.)
Is complete response confirmed
Is partial response confirmed
Notice Of Progression
Has the patient developed a first progression that has not been previously reported (or relapse)
Is the patient receiving any non-protocol cancer therapy not previously reported
Non-protocol endocrine therapy (includes medical and surgical)
Non-protocol surgery
Non-protocol radiation therapy
Other non-protocol therapy
Has a new primary cancer or MDS been diagnosed that has not been previously reported (myelodysplastic syndrome)
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