CALGB: 40101 ON-STUDY FORM Four Versus Six Cycles of Cyclophosphamide/Doxorubicin or Paclitaxel in Adjuvant Breast Cancer NCT00041119 Source Form: NCI FormBuilder:



  1. 8/26/12 8/26/12 -
  2. 3/23/15 3/23/15 - Martin Dugas
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March 23, 2015


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Breast Cancer NCT00041119

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  1. StudyEvent: CALGB: 40101 ON-STUDY FORM
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Amended data?
Patient data
Menopausal Status
Tumor Laterality (mark one with an X)
Receptor Status, ER (If measured in fmols/mg cytosol protein >= 10 is positive. If other measures are used apply institutional standards; borderline results should be reported as positive)
Receptor Status, PgR (mark one with an X)
Histologic Grade (combined histologic grade is used according to SBR/ELSTON classification.)
HER-2 neu Status
Prior hormonal therapy? (do not include steroids given with chemotherapy)
Prior adjuvant chemotherapy for this malignancy? (include pre-op chemotherapy at diagnosis)
Type of biopsy (mark one with an X)
Most extensive primary surgery (mark one with an X)
Sentinel node biopsy
If done, sentinel node biopsy results (per protocol)
Was axillary dissection performed?

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