E1105 Hypertension Status Form First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab in Treating Patients With Metastatic Breast Cancer That Overexpresses HER-2/NEU Source Form: NCI FormBuilder:

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  2. 8/8/14 8/8/14 - Martin Dugas
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  6. 8/7/15 8/7/15 - Martin Dugas
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August 7, 2015

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Creative Commons BY-NC 3.0 Legacy
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Hypertension Status Form Breast Cancer E1105 NCT00520975

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

General information
Off Treatment Report Period (since registration)
Reporting Period
On Treatment Report Period (Maintenance 1 cycle = 3 weeks)
Anti-Hypertensive Drugs

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