Description:

E5103 Hematology/Chemistry Form Doxorubicin, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3AE26832-8814-18AE-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3AE26832-8814-18AE-E044-0003BA3F9857
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  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
  5. 3/27/15 3/27/15 - Martin Dugas
Uploaded on:

January 8, 2015

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License :
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00433511 On-Study - E5103 Hematology/Chemistry Form - 2683765v1.0

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files

Header
Unnamed2
Unnamed3
Unnamed4
Unnamed Module 4
On Treatment Report Period
Off Treatment
Off Treatment Report Period (since registration - Choose one x)
Unnamed5
Were hematology/chemistry results obtained this report period (cycle)?
Pre-registration Hematology/chemistry
1000/uL
1000/uL
mmol/L
Units
CTC AE Attribution Code (Leave attribution box blank if no adverse event.)
Action taken for this AE for Chemotherapy
Action taken for this AE for Bevacizumab/Placebo
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