Description:

AMC-045 On Study Form (F02) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7284A0F2-BE97-FDEC-E040-BB89AD43537B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7284A0F2-BE97-FDEC-E040-BB89AD43537B

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Versions (2) ▾
  1. 8/26/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00324415 On-Study - AMC-045 On Study Form (F02) - 2936986v1.0

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  1. StudyEvent: AMC-045 On Study Form (F02)
    1. No Instruction available.
Header
Hiv History
CDC HIV Risk Group
Ccrr Module For On Study Form - Rf02b
Primary site
Prior Treatment? (If "Yes", Check below)
Prior Systemic Chemotherapy
Prior Biological Response Modifiers or Cytokines
Prior Surgery (excluding biopsy)
Prior cryotherapy
Prior systemic steroid treatment
Prior Radiation Therapy
Prior topical/intralesional therapy
Other Prior Therapy (e.g. Hyperthermia, etc.)
Other Prior Therapy (e.g. Hyperthermia, etc.)
Ccrr Module For On Study Form - Rf02b
History of Prior Malignancy
Primary site
Prior Treatment? (If "Yes", Check below)
Prior Systemic Chemotherapy
Prior Biological Response Modifiers or Cytokines
Prior Surgery (excluding biopsy)
Prior cryotherapy
Prior systemic steroid treatment
Prior Radiation Therapy
Prior topical/intralesional therapy
Other Prior Therapy (e.g. Hyperthermia, etc.)
Other Prior Therapy (e.g. Hyperthermia, etc.)
Antiretroviral Therapy
Agent use
Duration if prior agents received
Comments