ID
10872
Description
CALGB: 80405 TREATMENT AND RESPONSE FORM NCT00265850 Cetuximab and/or Bevacizumab Combined With Combination Chemotherapy in Treating Patients With Metastatic Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F39D6C01-851A-64CF-E034-0003BA3F9857
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Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 6/9/15 6/9/15 -
Uploaded on
June 9, 2015
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License
Creative Commons BY-NC 3.0 Legacy
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CALGB: 80405 TREATMENT AND RESPONSE FORM NCT00265850
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.
- StudyEvent: CALGB: 80405 TREATMENT AND RESPONSE FORM
Description
Patient demographics
Description
Patient Initials
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Description
Patient Hospital No
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C0421459
- NCI Thesaurus Property
- C16960
- NCI Thesaurus Property-2
- C25364
- NCI Thesaurus ObjectClass
- C16696
Description
Institution Name
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass-2
- C21541
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Description
Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Description
Study Number Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Trial subject ID Participating Group
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Description
Assessment of Chemotherapy
Description
Body Surface Area
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C0005902
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25157
Description
Cycle Number
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2045829
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25379
Description
Agent
Data type
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain
- C1708
- NCI Thesaurus ValueDomain-2
- C42614
Description
Agent Total Dose
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25304
- UMLS CUI-1
- C2986497
- NCI Thesaurus Property
- C25379
- NCI Thesaurus ValueDomain-2
- C25488
- NCI Thesaurus ObjectClass
- C1708
Description
Date Last Dose
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1762893
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25509
- NCI Thesaurus Property-2
- C25256
Description
Lab results
Description
LaboratoryProcedureMagnesiumResultSpecifiedValue
Data type
float
Measurement units
- mmol/L
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C29239
- UMLS 2011AA Property-2
- C0024467
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C38024
- UMLS 2011AA ValueDomain-2
- C0205369
Description
CalciumMagnesiumAgentReportPeriodAdministeredInd-2
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C331
- UMLS 2011AA ObjectClass
- C0006675
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus ObjectClass-3
- C29239
- UMLS 2011AA ObjectClass-3
- C0024467
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25375
- UMLS 2011AA Property-2
- C0684224
- NCI Thesaurus Property-3
- C25382
- UMLS 2011AA Property-3
- C1521801
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
Off-protocol treatment
Description
Off Treatment Reason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C1518544
- NCI Thesaurus ObjectClass
- C25601
- UMLS CUI-2
- C0566251
- NCI Thesaurus Property
- C25365
Description
Off Treatment Reason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25601
- UMLS CUI-1
- C1518544
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus ObjectClass-3
- C25415
- UMLS CUI-2
- C0566251
- NCI Thesaurus Property
- C25382
- NCI Thesaurus ValueDomain
- C25638
Description
Off-TreatmentOtherReasonSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus ObjectClass
- C25601
- UMLS 2011AA ObjectClass
- C1518544
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
Description
Weeks 1 And 2
Description
ProtocolAgentDoseModificationDecreaseScale
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C42651
- UMLS 2011AA ObjectClass
- C0442711
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25488
- UMLS 2011AA Property
- C0178602
- NCI Thesaurus Property-2
- C25572
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Metathesaurus ValueDomain
- CL235558
Description
Dose Modification Reason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C0392360
- NCI Thesaurus Property
- C25572
Description
Weeks 3 And 4
Description
Weeks 5 And 6
Description
Weeks 7 And 8
Description
Survival Date
Description
Patient Status
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Description
Primary Cause of Death
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Description
Primary Cause of Death, specify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass-2
- C25251
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- NCI Thesaurus Property-2
- C25365
- NCI Thesaurus ValueDomain
- C25685
Description
Date last contact
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0805839
- NCI Thesaurus Property
- C25461
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
Response Data
Description
LesionAssessmentDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C3824
- UMLS 2011AA ObjectClass
- C0221198
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ValueDomain-2
- C25367
Description
TumorResponseCDUSType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus Property
- C25755
- UMLS 2011AA Property
- C0871261
Description
Complete Response First Observed Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS CUI-1
- C0677874
- NCI Thesaurus ObjectClass-2
- C25250
- UMLS CUI-2
- C1115465
- NCI Thesaurus Property
- C25509
- NCI Thesaurus Property-2
- C25599
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
Partial Response First Observed Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25755
- UMLS CUI-1
- C1521726
- NCI Thesaurus ObjectClass-2
- C25378
- UMLS CUI-2
- C1115465
- NCI Thesaurus Property
- C25509
- NCI Thesaurus Property-2
- C25599
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Description
ProgressionFirstObservedDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25331
- NCI Thesaurus Property
- C25509
- UMLS 2011AA Property
- C1279901
- NCI Thesaurus Property-2
- C25599
- UMLS 2011AA Property-2
- C1441672
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
Description
Progression Site
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS CUI-1
- C0242656
- NCI Thesaurus Property
- C25341
- UMLS CUI-2
- C1515974
- NCI Thesaurus ObjectClass
- C25331
Description
Person Completing Form
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Description
FormOriginalCompleteDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19464
- UMLS 2011AA ObjectClass
- C0376315
- NCI Thesaurus Property
- C25250
- UMLS 2011AA Property
- C0205197
- NCI Thesaurus Property-2
- C25604
- UMLS 2011AA Property-2
- C0205313
- NCI Thesaurus ValueDomain-2
- C25367
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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.
- StudyEvent: CALGB: 80405 TREATMENT AND RESPONSE FORM
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C25415 (NCI Thesaurus ObjectClass-3)
C0566251 (UMLS CUI-2)
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C1521902 (UMLS 2011AA ValueDomain)
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C0205394 (UMLS 2011AA Property)
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