S1007 Prestudy Form (45282) Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder:


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  1. 8/27/12
  2. 1/9/15
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01272037 Pre-Study - S1007 Prestudy Form (45282) - 3141026v1.0

Instructions: Submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form

Disease Description
Menopausal Status (select one)
Tumor Laterality (select one)
ER Status
PgR Status
HER2 results/IHC
Additional Prestudy Data
Breast cancer was first detected by (select one)
Histologic Grade (combined histologic grade by SBR/Elston classification)
Nuclear Grade
Lymphovascular space invasion
Extranodal extension
Multifocal Tumors
Multicentric Tumors
Breast: Surgical Procedures
Most Extensive Primary Surgery (select one)
Was sentinel node sampling performed
Sentinel Node Biopsy Results
Was axillary dissection performed?

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