Description:

CALGB 40601 FOLLOW-UP FORM NCT00770809 Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A098B5D-E41F-1055-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A098B5D-E41F-1055-E044-0003BA3F9857

Keywords:
Versions (4) ▾
  1. 8/27/12
  2. 1/8/15
  3. 1/9/15
  4. 6/21/15
Uploaded on:

June 21, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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CALGB 40601 FOLLOW-UP FORM NCT00770809

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.

Header
Are data amended
Patient demographics
Vital Status
Patient's vital status (Mark one with an X.)
Primary cause of death (Mark one with an X.)
Did the patient continue treatment with AC?
Treatment Regimen
Did the patient continue treatment with trastuzumab?
Did the patient continue treatment with endocrine therapy for ER/PgR positive disease?
Has the patient had a documented clinical assessment for this cancer
Was patient restaged during this time period (If Yes, complete the following questions and submit C-817 Follow-Up Solid Tumor Measurement Form)
Overall Tumor Response
Notice Of Progression
Has the patient been diagnosed with a first local-regional progression (since submission of the last follow-up form?)
Site of First Local-Regional Progression
Has the patient been diagnosed with first distant progression?
How was this progression information obtained?
How was this progression information obtained?
Expected Adverse Events
Has the patient experienced any grade >= 2 treatment related adverse event? (prior to diagnosis of recurrence or new malignancy)
CTC adverse event term
CTC AE Attribution Code (^2)
Comments

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