Description:

E1305 Treatment Form NCT00588770 Chemotherapy With or Without Bevacizumab in Treating Patients With Recurrent or Metastatic Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=19F79B13-026F-5DCC-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=19F79B13-026F-5DCC-E044-0003BA3F9857
Keywords:
  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 6/16/15 6/16/15 -
Uploaded on:

June 16, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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E1305 Treatment Form NCT00588770

INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).

Header
Patient demographics
Arm A And Arm B
On Treatment Report Period
On Treatment
Patient Vital Status
Primary Cause of Death (if applicable)
ECOG Performance Status (Day 1 of this cycle)
Kg
Agent Name: Cisplatin
Was the agent Cisplatin administered during this reporting period (cycle)
Agent Name: Carboplatin
Was the agent Carboplatin administered during this reporting period (cycle)
mg/dL
Agent Name: Docetaxel
Was the agent Docetaxel administered during this reporting period (cycle)
Agent Name: 5-fu
Was the agent 5-FU administered during this reporting period (cycle)
Agent Name: Bevacizumab
Was the agent Bevacizumab administered during this reporting period (cycle)
Dose modification (Bevacizumab)
Non-protocol Therapy
Was any non-protocol therapy given during protocol treatment? (not previously reported)
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