E5103 Non-Protocol Therapy Form [Form No. 2814v2] NCT00433511 Doxorubicin, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer Source Form: NCI FormBuilder:


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  1. 8/26/12
  2. 1/9/15
  3. 6/18/15
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June 18, 2015

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E5103 Non-Protocol Therapy Form NCT00433511

Instructions: Use this form to capture the FIRST occurrence of non-protocol anti-tumor therapy per registration step ONLY if patient's disease is still stable or in partial or complete remission and has not progressed/relapsed from protocol therapy.

ECOG clinical trial administrative data
Reporting Period
Patient demographics
Data amendment
Non-Protocol Therapy
Non-Protocol Chemotherapy
Non-Protocol Hormonal Therapy?
Non-Protocol Immunotherapy? (/Biological Response Modifiers)
Non-protocol high dose chemotherapy/stem cell transplant (Autologous or Allogeneic)
Non-Protocol Surgery
Non-Protocol Radiation Therapy?
Other Non-Protocol Therapy
Was the non-protocol therapy given for the disease of this protocol (NOTE: Treatment for a second primary in the same organ site would not be considered therapy for disease of this protocol. - NOTE: Submit ECOG Second Primary Form if applicable.)

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