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Refractory tumors in children (NCT00053963) - Eligibility Worksheet (ADVL0212 NCT00053963)

- 20.03.15 - 1 Formular, 2 Itemgruppen, 32 Datenelemente, 1 Sprache

Itemgruppen: Header, Eligibility criteria

ADVL0212: Eligibility Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC07E8-6588-30D1-E034-0003BA12F5E7

Recurring cancer children (ADVL0212 NCT00053963) - Reporting Period Worksheet cancer (NCT00053963)

- 22.03.15 - 1 Formular, 5 Itemgruppen, 58 Datenelemente, 1 Sprache

Itemgruppen: Header, Patient characteristics, Concomitant Medication, Patient status, Adverse event

ADVL0212: Reporting Period Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC15B1-1989-311F-E034-0003BA12F5E7

ADVL0212: Death Worksheet NCT00053963

- 08.07.15 - 1 Formular, 3 Itemgruppen, 14 Datenelemente, 1 Sprache

Itemgruppen: Header, Death Assessment, CCRR MODULE

ADVL0212: Death Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAD089-F0A7-3073-E034-0003BA12F5E7

ADVL0212: Response Assessment NCT00053963

- 05.07.15 - 1 Formular, 5 Itemgruppen, 14 Datenelemente, 1 Sprache

Itemgruppen: Header, Sites of Measurable Disease at the Time of Study Entry, Evaluation of lesions, Comments, CCRR MODULE

ADVL0212: Response Assessment NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAE217-B511-30BD-E034-0003BA12F5E7

ADVL0212: On Study Worksheet [reload] NCT00053963

- 05.07.15 - 1 Formular, 7 Itemgruppen, 42 Datenelemente, 1 Sprache

Itemgruppen: Header, Treatment related information, Diagnosis, Hemogram, Chemistries, Comments, CCRR MODULE

ADVL0212: On Study Worksheet [reload] NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B304C5F5-C7EC-0452-E034-0003BA12F5E7

ADVL0212: Prior Therapy Worksheet NCT00053963

- 05.07.15 - 1 Formular, 6 Itemgruppen, 12 Datenelemente, 1 Sprache

Itemgruppen: Header, Anti-cancer therapy, Type of Prior Therapy, Comments, General Validations, CCRR MODULE

ADVL0212: Prior Therapy Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EADAE4-318A-307A-E034-0003BA12F5E7

ADVL0212: Relapse/Progression Worksheet NCT00053963

- 05.07.15 - 1 Formular, 3 Itemgruppen, 16 Datenelemente, 1 Sprache

Itemgruppen: Header, Relapse/Progression, CCRR MODULE

ADVL0212: Relapse/Progression Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAD72E-7E69-3077-E034-0003BA12F5E7

ADVL0212: On Study Worksheet (Leukemia) NCT00053963

- 05.07.15 - 1 Formular, 6 Itemgruppen, 45 Datenelemente, 1 Sprache

Itemgruppen: Patient demographics, Bone Marrow, Hemogram, Chemistries, Comments, CCRR MODULE

ADVL0212: On Study Worksheet (Leukemia) NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C10238B2-42BD-142E-E034-0003BA12F5E7

ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963

- 16.06.15 - 1 Formular, 5 Itemgruppen, 33 Datenelemente, 1 Sprache

Itemgruppen: Header, Eligibility Assessment, Comments, Treatment Assignment, CCRR MODULE

ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2D219-E599-53B9-E034-0003BA12F5E7

ADVL0212: Phase I Weekly Report NCT00053963

- 08.07.15 - 1 Formular, 5 Itemgruppen, 32 Datenelemente, 1 Sprache

Itemgruppen: Header, DLT Toxicity Data, Results of test completed during this weekly reporting interval, Comments, CCRR MODULE

ADVL0212: Phase I Weekly Report NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAF58D-ABF6-30C9-E034-0003BA12F5E7

ADVL0212: Secondary Malignancy Report Worksheet NCT00053963

- 05.07.15 - 1 Formular, 3 Itemgruppen, 12 Datenelemente, 1 Sprache

Itemgruppen: Header, Secondary Malignancy, CCRR MODULE

ADVL0212: Secondary Malignancy Report Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EADE06-A88A-30BB-E034-0003BA12F5E7

ADVL0212- Review Form (Dr. Chin) NCT00053963

- 03.06.15 - 1 Formular, 2 Itemgruppen, 8 Datenelemente, 1 Sprache

Itemgruppen: ECG Assessment, CCRR MODULE

ADVL0212- Review Form (Dr. Chin) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2E959-BAAB-54D8-E034-0003BA12F5E7 NCT00053963

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