CALGB: Follow-up Solid Tumor Evaluation Form NCT00053339 Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder:


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  1. 8/26/12
  2. 7/8/15
  3. 7/8/15
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July 8, 2015

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CALGB: Follow-up Solid Tumor Evaluation Form NCT00053339

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. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.

CALGB clinical trial administrative data
Amended data?
Patient demographics
Target Lesion(s) Follow-up Evaluation
Method of Evaluation
If other, specify (method of evaluation)
Response Status at this assessment (Target Lesion)
Non-target Lesion(s) Follow-up Evaluation
Are there any non-target lesions?
New Lesion(s) At Follow-up Evaluation
Was the appearance of any new lesions documented since the baseline evaluation?
Ccrr Module For Calgb: Follow-up Solid Tumor Evaluation Form

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