Description:

Fast Fact Sheet for Protocol 0209 (endometrial) Combination Chemotherapy in Treating Patients With Stage III, Stage IV, or Recurrent Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=53CE53A6-C7B5-2895-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=53CE53A6-C7B5-2895-E044-0003BA3F9857

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Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Endometrial Cancer NCT00063999 Eligibility - Fast Fact Sheet for Protocol 0209 (endometrial) - 2770341v1.0

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  1. StudyEvent: Fast Fact Sheet for Protocol 0209 (endometrial)
    1. No Instruction available.
Tracking Information
Ethnicity
Method of Payment
Race
Race
Module 1
Patient signed consent
Has the patient provided written authorization permitting release of personal health information
What is the site of the disease
What is the cell type
Histologic Grade (Differentiation)
Stage
Was the recurrence diagnosed histologically
Is there potential for cure by radiation and/or surgery
Does the patient have measurable disease
Is the measurable disease >= 20 mm when measured by conventional techniques, including palpation, plain X-ray, CT and MRI or >=10mm when measured by spiral CT
Is estrogen receptor and progesterone receptor status of the primary tumor available
Lab Results
Prior Radiation Therapy
Was external beam RT delivered to the pelvis
Was external beam RT delivered to the peri-aortic lymph node region or to the abdomen
Did the patient have intracavitary radiation therapy to the vagina
Have at least 4 weeks elapsed since completion of radiation therapy if it involved the whole pelvis or more than 50% of the spine
Lab Results:
1000/uL
Is the Serum Creatinine less than or equal to ULN
Is SGPT (ALT) less than or equal to 3 X Upper Limits of Normal
Is Bilirubin less than or equal to institutional upper limit of normal
Will the patient have the following paramenters measured within 14 days prior to initiating protocol therapy
Will the patient have the following parameters measured within 28 days prior to initiating protocol therapy
Has the patient had an EKG
Performance Status
Has the patient met the pre-entry requirements as specified in section 7.0
Does the patient have a concomitant malignancy other than non-melanoma skin cancer
Has the patient had any prior cancer diagnosed?
Has the patient been disease-free for 5 or more years and had no prior chemotherapy for previous malignancy
Unnamed2
Does the patient have third-degree or complete heart block
Is a pacemaker in place
Does the patient have a chronic disease
Does the patient have a history of myocardial infarction within 6 months before enrollment, New York Heart Association (NYHA) Class II or greater heart failure or symptoms suspicious for congestive heart failure
Has the patient had a left ventricular ejection fraction in the past 6 months that is documented to be 50% or greater
%
Has the patient had an LVEF of less than 50% in the last 6months
Are there circumstances that will not permit patient to complete therapy or adequate follow-up
Is the patient sensitive to E. Coli-derived drug preparations
Is the patient age 18 years or older
Stratification
Comments

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