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Treatment History CRFs Multiple Sclerosis Tysabri NCT00027300

- 1/27/17 - 1 form, 1 itemgroup, 6 items, 1 language
Itemgroup: MS Treatment History
The purpose of this study is to determine the safety and efficacy of natalizumab in the treatment of individuals who have been diagnosed with relapsing remitting multiple sclerosis (MS). It is hoped that natalizumab will prevent certain types of white blood cells from moving out of the bloodstream into organs, including the brain, that are being damaged by autoimmune disease (a disease in which the body's own immune system attacks certain organs). These white blood cells are thought to cause inflammation that can result in lesions (small areas of damage) in the brain. These lesions are thought to be the cause of relapses and disability in MS. Documentation process: This form ist to be obtained in Screening

Treatment deferral Multiple Sclerosis ALAIN01 NCT02419378

- 5/28/16 - 1 form, 1 itemgroup, 13 items, 1 language
Itemgroup: Treatment deferral
Alemtuzumab in Autoimmune Inflammatory Neurodegeneration: Mechanisms of Action and Neuroprotective Potential (ALAIN01) https://clinicaltrials.gov/ct2/show/NCT02419378 Principal Investigator Prof. Dr. Dr. Sven Meuth, University Hospital Muenster, Germany

Treatment - Brain Cancer - Neurologic Evaluation Form - 2286577v3.0 - Brain Cancer - Neurologic Evaluation Form

- 1/9/15 - 1 form, 3 itemgroups, 32 items, 1 language
Itemgroups: CRF Header, Brain: Form Administration, Brain: Neurologic Evaluation
Brain Cancer - Neurologic Evaluation Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE951920-1FCC-25F8-E034-0003BA12F5E7

On-Study Form Brain Metastases NCT00377156

- 7/25/15 - 1 form, 5 itemgroups, 14 items, 1 language
Itemgroups: Header, Description of Primary Disease, Disease/History, Neurologic Examination, Height
On-Study - North Central Cancer Treatment Group On-Study Form - 2467371v1.0 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=104D18F2-219E-2AE1-E044-0003BA3F9857

Treatment - Brain Cancer - Treatment by Cycle Form - 2287531v3.0 - Brain Cancer - Treatment by Cycle Form

- 1/9/15 - 1 form, 7 itemgroups, 48 items, 1 language
Itemgroups: CRF Header, Brain: Treatment Reporting Interval, Brain: Treatment Cycle Information - Clinical Evaluation Follow-up, Brain: Treatment Cycle Information - Systemic Therapy, Brain: Treatment Cycle Information - Concomitant Therapy, Brain: Treatment Schedule - Non-Protocol Therapy, Comments
Brain Cancer - Treatment by Cycle Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E51F0AB1-37FF-4133-E034-0003BA3F9857

Treatment - Brain Cancer - Definitive Surgery Form - 2286489v3.0 - Brain Cancer - Definitive Surgery Form

- 1/9/15 - 1 form, 5 itemgroups, 20 items, 1 language
Itemgroups: CRF Header, Brain: Form Administration, Brain: Surgical Treatment for Primary Site, Brain: Most Recent Surgery, Comments
Brain Cancer - Definitive Surgery Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE9506AA-7EEF-2525-E034-0003BA12F5E7

Treatment - Brain Cancer - Radiation Therapy Treatment Form - 2286709v3.0 - Brain Cancer - Radiation Therapy Treatment Form

- 1/9/15 - 1 form, 3 itemgroups, 18 items, 1 language
Itemgroups: CRF Header, Brain: Radiation Therapy, Comments
Brain Cancer - Radiation Therapy Treatment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE952E13-775D-272C-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00053963 Treatment - ADVL0212: Reporting Period Worksheet (Leukemia) - 2172521v3.0 - Reporting Period Worksheet (Leukemia ADVL0212)

- 3/12/15 - 1 form, 7 itemgroups, 66 items, 1 language
Itemgroups: Header, Patient characteristics, Treatment, Concomitant Medication, New Cancer, Follow-Up, Adverse event
ADVL0212: Reporting Period Worksheet (Leukemia) 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=C0F387DC-C9D3-5664-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00890747 Treatment - AMC-061 Concomitant Medication Form (MED) - 2935086v1.0 - AMC-061 Concomitant Medication Form (MED)

- 1/9/15 - 1 form, 2 itemgroups, 12 items, 1 language
Itemgroups: Concomitant Medications, Comments
AMC-061 Concomitant Medication Form (MED) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F951-68F0-E040-BB89AD4358A1

Brain and Central Nervous System Tumors NCT00978458 Treatment - E3F05 Chemotherapy Form - Arm B Only - 2904374v1.0 - Chemotherapy Form Glioma (Arm B, E3F05)

- 1/1/15 - 1 form, 5 itemgroups, 31 items, 1 language
Itemgroups: Header Module, Vital Status, Patient Characteristics, Therapy Administered, Non-Protocol Therapy
E3F05 Chemotherapy Form - Arm B Only Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma NCT00978458 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6D055B43-63F1-A6F7-E040-BB89AD436A92

Brain and Central Nervous System Tumors NCT00890747 Treatment - AMC-061 Study Drug Administration Form (DA1) - 2913633v1.0 - AMC-061 Study Drug Administration Form (DA1)

- 1/9/15 - 1 form, 3 itemgroups, 9 items, 1 language
Itemgroups: Header Module, Study Drug Administration, Footer Module
AMC-061 Study Drug Administration Form (DA1) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6DBDC738-4455-D324-E040-BB89AD433B23

Lung Cancer NCT00096265 Treatment - TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form - 2277910v3.0 - TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form

- 1/9/15 - 1 form, 1 itemgroup, 74 items, 1 language
Itemgroup: Header
TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D81D1978-6B15-04EC-E034-0003BA12F5E7

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