Description:

E1105 Follow-Up Disease Evaluation Form (RECIST) NCT00520975 First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab in Treating Patients With Metastatic Breast Cancer That Overexpresses HER-2/NEU Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=18CBCC2B-91FD-6306-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=18CBCC2B-91FD-6306-E044-0003BA3F9857

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

June 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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E1105 Follow-Up Disease Evaluation Form (RECIST) NCT00520975

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center according to the forms submission schedule

Header
Patient demographics
Data amendment
Reporting Period
On Treatment Report Period (Maintenance 1 cycle = 3 weeks)
On Treatment Report Period (Maintenance 1 cycle = 3 weeks)
Off Treatment
Off Treatment Report Period (since registration)
Target Lesions
Site Code
Method of Evaluation
cm
cm
Nontarget Lesions
Site Code
Method of Evaluation
Follow-up Status of Lesion (s)
Cytology Result (For Site Code 04 ONLY)
New Lesions
Was the appearance of any new lesions documented
Site Code
Method of Evaluation
Cytology Result (For Site Code 04 ONLY)
Response Of Target Lesions This Reporting Period
Has the response of the target lesions changed, OR has an unconfirmed response changed to a confirmed response, since last report ([NOTE: Code 'yes' if this is the FIRST documentation of stable disease.])
Response status at this assessment (target lesions)
Overall Response Per Recist Criteria - Target, Nontarget And New Lesions
Has the overall response changed, OR has an unconfirmed response changed to a confirmed response, since last report ([NOTE: Code ?yes? if this is the FIRST documentation of stable disease.])
Overall response status at this assessment
Has response been confirmed by second assessment (For CR or PR)
Symptomatic Deterioration
Is there symptomatic deterioration of the patient's health status requiring discontinuation of treatment (this reporting period)
Comments

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