Description:

CALGB 80702 Treatment Form Oxaliplatin, Leucovorin Calcium, and Fluorouracil With or Without Celecoxib in Treating Patients With Stage III Colon Cancer Previously Treated With Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7AD9B90F-EC60-48A2-E040-BB89AD430CF4

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7AD9B90F-EC60-48A2-E040-BB89AD430CF4
Keywords:
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

DOI:
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Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT01150045 Treatment - CALGB 80702 Treatment Form - 2969857v1.0

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. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. If data are amended, circle amended items and check the "Yes" box. If submitting by mail, retain a copy for your records. If submitting by fax, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the form

Header
Are data amended
Unnamed2
Patient Data
m2
First Treatment (cycles 1 ¿ 6)
Dose Modifications
Were there any dose modifications or additions/omissions to protocol treatment? (Mark one with an X.)
Reason Treatment Ended
Reason Treatment Ended (If protocol treatment has been terminated permanently during this time period Mark one with an X.)
Did the patient receive any ancillary therapy during this reporting period
Overall Response

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