Description:

AMC-045 Type III Adverse Event Reporting Form (TAE) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1C146B28-823F-583B-E044-0003BA3F9857

Lien:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1C146B28-823F-583B-E044-0003BA3F9857
Mots-clés:
  1. 26/08/2012 26/08/2012 -
  2. 26/11/2014 26/11/2014 - Martin Dugas
  3. 13/04/2021 13/04/2021 - Dr. rer. medic Philipp Neuhaus
  4. 13/04/2021 13/04/2021 - Ahmed Rafee, MD
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foglt
Téléchargé le:

13 avril 2021

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Creative Commons BY 4.0
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Anal Cancer NCT00324415 Toxicity - AMC-045 Type III Adverse Event Reporting Form (TAE) - 2516535v1.0

This form should be completed at week 18 for Type III Adverse Events. Type III Adverse Event - (1) any interruption in radiation therapy lasting more that 7 days, (2) failure to complete at least 6 courses of cetuximab and 2 cycles of cisplatin and 5-FU due to toxicity, (3) failure to complete the prescribed course of irradiation due to toxicity

Header module
Type III Adverse Events
Has the patient experienced a Type III adverse event
Was RT interrupted for more than one week?
Has the subject failed to receive 6 courses of cetuximab and 2 cycles of cisplatin and 5-FU due to toxicity
Has the subject failed to complete the prescribed course of irradiation due to toxicity
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