CALGB-40502 On-Study Form NCT00785291 Paclitaxel, Paclitaxel Albumin-Stabilized Nanoparticle Formulation, or Ixabepilone With or Without Bevacizumab in Treating Patients With Stage IIIC or Stage IV Breast Cancer Source Form: NCI FormBuilder:

  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/16/15 6/16/15 -
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June 16, 2015

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Creative Commons BY-NC 3.0 Legacy
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CALGB-40502 On-Study Form NCT00785291

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.

Are data amended
Patient demographics
Patient Characteristics
ECOG Performance Status (Mark one with an X.)
Disease Description
ER status (Mark one with an X.)
PgR status (Mark one with an X.)
Timing of assay (Mark one with an X.)
Timing of assay (Mark one with an X.)
Her2/neu Status
IHC Lab Value (Mark one with an X.)
Site Of Progression Or Recurrence
Sites of Progression (Mark all that apply with an X.)
Prior Treatment - Systemic Regimens
Prior Treatment Regimen Type
Required Laboratory Values
Serum Beta-HCG (OR)
Urine Beta-HCG
Urine Protein (Mark one with an X.)
g/24 hours
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