Description:

Randomized Placebo-Controlled Phase III Trial of Letrozole Alone or Letrozole and Tipifarnib (Zarnestra, R115777) for Postmenopausal women with ER/PR+ Tamoxifen resistant MBC CALGB_40301_ON_STUDY_FORM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E53B0CD1-788E-25B9-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E53B0CD1-788E-25B9-E034-0003BA3F9857

Keywords:
Versions (4) ▾
  1. 8/26/12
  2. 1/9/15
  3. 6/9/15
  4. 8/21/15
Uploaded on:

August 21, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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On Study Breast Cancer CALGB_40301

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
Patient Characteristics
Post menopausal
Is patient on ovarian suppression with GnRH-A agonist
Disease Description
ER status (Mark one with an X.)
PgR status (Mark one with an X.)
Timing of assay (Mark one with an X.)
Timing of assay (Mark one with an X.)
Site Of Progression Or Recurrence
Site of progression (s)
Prior Systemic Therapy
Prior adjuvant hormonal therapy (Do not include steroids given with chemotherapy.)
Prior endocrine therapy for metastasis or recurrence (Do not include steroids given with chemotherapy.)
Prior adjuvant chemotherapy (Include pre-op chemotherapy at diagnosis.)
Prior chemotherapy for metastasis or recurrence
Prior adjuvant high dose chemotherapy/Autologous stem cell transplant (HDC/ASCT )
Prior High-Dose Chemotherapy with Autologous Stem Cell Transplant for metastasis or recurrence
Prior adjuvant immunotherapy
Prior immunotherapy for metastasis or recurrence
Prior adjuvant other therapy
Prior other therapy for metastasis or recurrence
Prior Systemic Regimens
Prior treatment regimen type
Required Laboratory Values
1000/uL
1000/uL
mg/dL
mg/dL
mg/dL
U/L
U/L
U/L
U/L
Was tumor marker information available for the following (Mark all that apply with an X.)
µg/L
kU/L
U/ml

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