Description:

Southwest Oncology Group S0600 Registration Worksheet Irinotecan and Cetuximab With or Without Bevacizumab in Treating Patients With Metastatic Colorectal Cancer That Progressed During First-Line Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E16B1D7-6F02-2C29-E040-BB89AD4317D7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E16B1D7-6F02-2C29-E040-BB89AD4317D7

Keywords:
Versions (2) ▾
  1. 8/27/12
  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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Colorectal Cancer NCT00499369 Registration - Southwest Oncology Group S0600 Registration Worksheet - 2994609v1.0

INSTRUCTIONS: All of the information on this Registration Worksheet and the Protocol Eligibility Section must be answered appropriately for a patient to be considered eligible for registration. This Registration Worksheet must be entirely filled out and referred to during the registration. Do NOT submit this worksheet as part of the patient data.

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SWOG Patient ID Status
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Patient Information
Stratification Questions
Planned concurrent chemotherapy
Time from last dose of bevacizumab
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I agree to allow my study doctor, or someone approved by my study doctor, to contact me regarding future research involving my participation in this study
Patient Eligibility
Has the Southwest Oncology Group Registration Worksheet been completed entirely and is the patient eligible according to the current version of protocol section 5.0

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