rave data entry guidelines s1400 & sub-studies 16e... · 2018-02-06 · rave data entry...
TRANSCRIPT
RAVE DATA ENTRY GUIDELINES
S1400 & SUB-STUDIES
Protocol Ver.
1/8/18
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Case Report Forms
S1400 Forms
Onstudy: Patient & Disease Description Form 3
Onstudy: Prior Treatment Form 4
Source Documentation: Baseline 5
S1400 Request for Sub-study Reassignment 6
S1400 Request for NEW Sub-study Assignment 7
Notice of Progression 8
Status Update Form 9
Intention not to Register Form 10
Follow-up Form 11
Notice of Death Form 12
S1400A, G, and I Sub-Study Forms
Onstudy: Patient & Disease Description Form 13
Onstudy: Prior Treatment 14
Onstudy: Laboratory Values 15
Pre-Treatment Laboratory Values 17
Smoking Status Assessment 18
Source Documentation: Baseline 19
Tumor: Assessment – Disease Assessment 20
Tumor: Target Lesions 21
Tumor: Non-Target Disease 22
Follow-up Tumor: Assessment 23
Treatment Form 24
Treatment Dose Modification Due to AE Form 25
Adverse Events: Assessment 26
Adverse Events: Report 27
Immune-Related Adverse Event – S1400I 30
Site(s) of Progression or Relapse 31
Off Treatment Notice 32
Advanced NSCLC Follow-up Form 33
Notice of Death Form 34
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Case Report Forms (Cont.)
S1400F & S1400K Sub-study Forms
Eligibility Criteria 35
Onstudy: Patient and Disease Description 36
Onstudy: Laboratory Values 36
Onstudy: Prior Treatment 38
Treatment Form 39
Adverse Events: Report 41
Immune-Related Adverse Event 43
End of Study 44
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If the patient’s tumor tissue was tested for PD-L1 expression, please
complete this section utilizing information from the PD-L1 report.
The “Assay” refers to the antibody, not the lab that performed the
testing.
If you are unsure about how to complete any of these fields, upload
a redacted copy of the associated PD-L1 report into the “Source
Documentation: Baseline” folder or email the DC’s a copy
([email protected]) to provide guidance.
S1400 Screening Forms
Onstudy: Patient & Disease Description Form
As there are several different conversion charts available for Karnofsky to Zubrod, it is important that
the Zubrod scale be used. If the Karnofsky is used, the Zubrod value must also be documented in
the medical record.
This form is due within 7 days of registration to S1400. Late submission > 3 months is
considered a major data delinquency deficiency for baseline forms.
Height, Weight & P/S must be
obtained within 28 days prior to
study entry. The values closest to
the registration date are reported.
The AJCC clinical stage is the stage at
the time of study entry, not at
original diagnosis. If patient has
metastatic disease, either M1a or
M1b are entered.
If T and N stage are unknown, enter
TX, NX, M1a, for example. If patient has had a cigarette within the past
year, they are considered a current smoker.
The date of current staging is the
date of the most recent test to
assess disease (usually a scan or
biopsy). It is not the date of a
physical exam unless a measurement
of a lesion is done at the visit (e.g.
skin lesion assessed).
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S1400 Screening Forms
Onstudy: Prior Treatment Form
The patient is considered a screening patient if they have progressed on current
systemic therapy for stage IV or recurrent disease at the time of registration.
The patient is considered a pre-screening patient if they are currently receiving
systemic treatment for stage IV or recurrent disease and have not progressed
yet.
This form is due within 7 days of registration to S1400. Late submission >3
months is considered a major data delinquency deficiency for baseline
forms.
If patient registered as:
Pre-screening, the
answer would be ‘No’,
and the following
treatment questions
would be left blank.
Screening, enter ‘Yes’
& answer the next
questions.
For Screening patients:
Enter the last date of any
treatment received, not
necessarily the date of
the last platinum (this
includes Nivolumab).
Enter the date of the first
scan or biopsy that
confirmed progression,
after the most recent
course of chemotherapy
but BEFORE registration
to this step.
This is the date the form was signed by the pathologist, not the date of the
pathology report, or when the specimen was obtained or submitted. The form
cannot be signed by the CRA/nurse.
The Local Pathology Review Form is due within 7 days of Screening/Pre-
Screening Registration. Retain a copy of this form in the patient’s research file.
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S1400 Screening Forms
Source Documentation: Baseline
Within 7 days of registration, upload:
The pathology report for the initial diagnosis documenting histological confirmation of
squamous cell carcinoma and lung primary
The Local Pathology Review Form signed by the pathologist prior to specimen submission.
Information Regarding the S1400 Local Pathology Review Form
Please ensure you are using the most recent version of the Local Pathology Review Form by
checking the version number located on the bottom right-hand side of the form.
As of October 2017, the most recent version of the Local Pathology Review Form is Version 1.3.
The form version in the Master Form Set will always be the most up-to-date; the Master Form Set
can be accessed on the S1400 protocol pages on CTSU.org and SWOG.org.
If another specimen is submitted, a second Local Pathology Review Form should be completed.
Save a copy of all forms for source documentation of adequate tissue confirmation.
The date of procedure is the date the test was done, not the date the document is uploaded or
the date of the report.
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S1400 Screening Forms
S1400 Request for Sub-study Reassignment
This form is submitted after receiving a sub-study assignment if the patient does not fulfill the assigned sub-study-specific eligibility criteria.
If needed, this form can
be added from the “Add
Event” drop down box on
the subject tab.
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S1400 Screening Forms
S1400 Request for NEW Sub-study Assignment
This form is ONLY for patients who have progressed on a sub-study and wish to register to a new sub-study.
If needed, this form can
be added from the “Add
Event” drop down box on
the subject tab.
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S1400 Screening Forms
Notice of Progression
For pre-screening patients, submit this form within 7 days of progression on current therapy.
This form will trigger the sub-study assignment for the patient the next morning (provided 16 days
have passed since the S1400 Pre-screening registration).
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S1400 Screening Forms
Status Update Form
Submit this form within 21 days of receiving a sub-study assignment, if the patient
has not yet registered to their assigned sub-study. If the Notice of Intention not to
Register is submitted, this form is no longer required.
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If needed, this form can be added from the “Add Event” drop down box
on the subject tab.
S1400 Screening Forms
Notice of Intention Not to Register
Submit this form within 7 days of the decision not to register patient to a sub-study.
Although the patient will not go onto a sub-study, follow-up continues per Section 14 of the
protocol.
This is the date documented
in the medical record that
the physician decided the
patient will not go on to a
sub-study.
If tissue was inadequate, there should be documentation whether or not the
patient allowed a second biopsy.
If patient was not eligible for the sub-study, there should be documentation
that a request for sub-study reassignment was submitted, if applicable.
This is the last documented
contact with the patient.
If source documents indicate
that patient will receive
additional treatment, report
it here.
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S1400 Screening Forms
Follow-up Form
Submit this form at the following time points:
For screening/pre-screening patients: Every three months for the first year, then every six months for
the second year and annually thereafter after until sub-study registration, the end of Year 3, or
patient’s death (whichever comes first).
For patients who will not be registered to a sub-study: every six months for two years and at the end
of Year 3, or patient’s death.
This includes treatment
with commercial agent(s)
that patient received
after going off treatment
(e.g. Ipilimumab).
This is cranial radiation
when there are no signs
of metastatic disease to
the brain.
If any clinic visits, phone
calls, labs, scans, biopsies,
etc. were done since the
last activity date, this
should be ‘Yes.’
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S1400 Screening Forms
Notice of Death Form
Submit this form within 28 days of knowledge of death.
Source documentation must
be available to support the
cause of death that is
reported.
The source(s) indicated will be
viewed at the time of audit.
More than one source can be
selected.
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Record the values closest to the date prior to sub-study registration.
Record the stage at the time of sub-study registration. If metastatic disease is present, this is either M1a or M1b. registration.
The stop date & dose of corticosteroids must be documented in the medical record.
If the patient has
treated brain
metastasis, and
there is no
subsequent scan
demonstrating
resolution of the
lesions, answer
‘Yes’.
If unsure about how to complete this section, email [email protected] or upload into the Rave “Source Documentation: Baseline” folder a redacted copy of the PD-L1 report for assistance.
S1400 Sub-Study Forms
Onstudy: Patient & Disease Description Form
Submit this form within 7 days of registration to a sub-study.
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Palliative radiation
means for pain or
symptom control,
not for a disease
response (e.g. spine
RT for pain control).
This is generally
radiation for stage
I – III lung cancer.
This is major
surgery, not a
biopsy or port
placement.
If more than one
drug, please list each
drug on a separate
line. Include all
treatment for this
cancer (stage I – IV).
1400 Sub-Study Forms
Onstudy: Prior Treatment
For S1400G: This is the best response to the patient’s prior platinum-based chemotherapy
treatment. Per S1400G eligibility, the patient must be platinum-sensitive. This question is only on the
S1400G Prior Treatment Form.
Submit this form within 7 days of registration to a sub-study.
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S1400 Sub-Study Forms
Onstudy: Laboratory Values
Baseline: record the values obtained closest to the date of registration.
Treatment cycles: record the values obtained on or just prior to Day 1 of the next cycle (e.g. For
Cycle 1, you would record Cycle 2/Day 1 labs).
Submit this form
Baseline: Within 7 days of registration
Treatment: Within 7 days after each cycle
If no 24-hour urine is done, leave the measured creatinine clearance blank. The calculated creatinine clearance value auto populates from the data entered into RAVE.
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S1400 Sub-Study Forms
Sub-study I:
Submit this form immediately within 7 days after each cycle.
This is Free T3 & T4, not total T3 & T4. For conversion to ng/dL see: http://endmemo.com/sconvert/pg_mlng_dl.php
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S1400 Sub-Study Forms
Pre-Treatment Laboratory Values
Enter ‘Yes’ if additional laboratory values were obtained before Treatment on Cycle 1, Day 1.
If ‘Yes,’ the Pre-Treatment Lab Form will appear. Enter the Cycle 1 Day 1 labs on this form.
The “Calculated creatinine clearance” will auto populate after the Cycle 1 weight is entered on the Cycle 1 Treatment form. An overdue icon may appear until the Cycle 1 Treatment form is submitted, but no further action is required on this form.
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S1400 Sub-Study Forms
Smoking Status Assessment
These questions should be answered by the patient at Baseline & at Off-Treatment. A copy of this
form can be printed for the patient to complete. There should be documentation of the date and who
completed the form (e.g. If patient completes the form, they should sign and date it).
The form can be obtained from the Master Forms Set available on the protocol page on
both the SWOG and CTSU websites. Scroll through the Master Forms Set to the
Smoking Status Assessment Form.
If utilizing a progress note to support the data entered on this form, it should be clear that these
questions were asked specifically of the patient.
This form is due within 7 days of registration to the sub-study & within 7 days of going off-
treatment.
If patient answers ‘less than one year’, they are considered a current smoker.
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S1400 Sub-Study Forms
Source Documentation: Baseline
Upload the reports for:
CT or MRI brain scan
CT of the Chest/Abdomen/Pelvis
Any other report used to assess baseline disease PRIOR to sub-study registration
These documents should be uploaded in RAVE within 7 days of registration to the sub-study.
Click on the browse button to locate
the document on your computer to
upload.
This should be the date the scan or
procedure was performed, not the
date of the report.
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S1400 Sub-Study Forms
Baseline Tumor: Assessment – Disease Assessment
Submit this form within 7 days of sub-study registration.
All scans used to assess disease are to be uploaded into TRIAD within 7 days per Section 15.
If CT or MRI brain scan, or other negative test was done, list it here.
If a PET scan was done within 42 days prior to registration to the sub-study, enter ‘Yes’ and the date.
If following target lesions – enter yes.
If following non-target lesions – enter yes.
If the physician is giving the reported measurements, then physician should be listed here.
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S1400 Sub-Study Forms
Tumor: Target Lesions
Source documentation must exist to support measurements entered here.
The same method of measurement at baseline must be used at each assessment.
For lymph nodes, record the smallest (short axis) diameter (must be > 1.5 cm to be a measurable
lesion).
Nodules are generally not considered lymph nodes.
This value auto
populates.
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S1400 Sub-Study Forms
Tumor: Non-Target Disease
Non-measurable lesions can include:
Measurable lesions that were not selected as target lesions. Since only two lesions per organ and five lesions in total can be selected as target lesions, any additional lesions should be followed as non-target disease.
Small lesions (longest diameter < 1.0 cm or pathologic lymph nodes with ≥ 1.0 cm to <1.5 cm short axis). Note: Lymph nodes that have a short axis < 1.0 cm (10 mm) are considered non-pathological and should not be recorded or followed.
Bone lesions, leptomeningeal disease, ascites, pleural/pericardial effusions, lymphangitis cutis/pulmonitis, inflammatory breast disease, and abdominal masses (not followed by CT or MRI).
Previously radiated lesions that have not progressed.
All baseline sites of disease must be captured somewhere on the Baseline Tumor
forms (either as target lesions or non-target disease).
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For sub-study A and sub-study F, patient must have a confirmation scan >
28 days from initial scan showing progression to meet irProgression criteria
in section 10.0. If progression is shown on the subsequent scan, the date of
the initial progression scan is reported as the progression date.
S1400 Sub-Study Forms
Follow-up Tumor: Assessment
Source Documentation: Follow up – Follow-up Tumor Assessment Form
Scan reports must be uploaded to RAVE in addition to submitting the scan(s) within 7 days to
TRIAD per Section 15.
Enter any new lesion(s)
here. Presence of new
lesions constitutes
progression. If the
report states lesion
increased in size from
prior scan, then it
probably is not a new
lesion.
If symptomatic
deterioration is yes,
there should be
documentation in the
Medical Record that
the patient’s
performance status
has decreased.
If patient progressed,
answer ‘No’ to
symptomatic
deterioration.
For S1400I
only (added
10/2/17).
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S1400 Sub-Study Forms
Treatment Form
** Be conscious of the dates. There should be no gaps in dates between cycles. **
Sub-study I:
This is the date treatment
started for this cycle.
These values should be from
Day 1 of the cycle before
treatment is given. Utilize your
institution’s formula for BSA.
This should be Day 1 of the
next cycle or 30 days after the
last treatment was given if
removed from study
treatment.
This date should be at the end
of the cycle & can be Day 1 of
the next cycle (when the
toxicities are assessed).
Complete the row only for the medication the patient is taking. Leave the others blank.
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S1400 Sub-Study Forms
Sub-study G:
Treatment Dose Modification Due to AE Form
If treatment was held, reduced or omitted, record the reason on this form.
Pharmacokinetic (PK) analysis is required for all patients on S1400G. Please see section 15.3 for additional details
regarding specimen collection and submission.
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S1400 Sub-study Forms
Adverse Events: Assessment
Review all toxicities occurring throughout the cycle. If the toxicity assessment is done on Day 1 of
the next cycle (before treatment), then those toxicities should be recorded in the prior cycle. For
example, if patient is found to have a rash at the toxicity assessment on Day 1 of Cycle 2, this is
reported in Cycle 1.
Make sure and check all laboratory values. If any laboratory values are out of range, they must be
graded per CTCAE 4.0 and reported as an adverse event. If an adverse event occurs in the labs
drawn on Day 1 of a cycle, the toxicity is reported for the previous cycle.
DO NOT report a condition existing at baseline unless it increases in grade, or returns to normal and
then returns.
Sub-study A has adverse events of special interest that require expedited reporting in CTEP-AERS.
> Grade 1 pneumonitis
> Grade 2 AST or ALT if after evaluation it meets Hy’s Law
Grade 2 bilirubin
Any grade Infusion Reactions
Any Grade Hypersensitivity Reactions.
Sub-study G has adverse events of special interest that require expedited reporting in CTEP-AERS.
> Grade 2 AST or ALT
> Grade 2 bilirubin
Sub-study F also has adverse events of special interest, which are outlined in the S1400F forms
section.
These dates should
match the reporting
period on the treatment
form, except for the last
cycle (see help text).
All toxicities grade 1 – 5
are reported even if the
event is felt not to be
clinically significant. The
only exceptions are
those present at baseline
that have not worsened
in grade or reoccurred.
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S1400 Sub-study Forms
Adverse Events: Report
DO NOT record a condition existing prior to registration.
If a toxicity continues to the next cycle, check ‘AE ongoing,’ and add that toxicity to the next cycle’s
adverse event report with the start date from the previous report period. Continue adding the AE for
each cycle until it ends. Enter the end date on the cycle where the AE ended.
If a baseline toxicity resolves during treatment, then comes back, you will then add that adverse
event to the report.
Be sure to check all laboratory values done throughout the cycle and not just the ones done on Day1
of the subsequent cycle. Laboratory values that are out of range are reported, even if not clinically
significant.
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S1400 Sub-study Forms
Adverse Events: Report – For S1400A MEDI4736 patients only
For patients who received MEDI4736 on S1400A, retrospective data collection regarding immune-
related adverse events (irAEs) will be required starting with the release of Lung-MAP Revision #9/10
on 10/2/2017. On this form, please indicate if any immune-related AEs were seen during the cycle.
If “Yes” is selected as the response to the question “Were any adverse events seen in this reporting
period immune-related?”, for each adverse event listed in the cycle, please indicate “Yes” or “No” to
the “Is the AE immune-related?” field that generates.
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S1400 Sub-study Forms
Adverse Events: Report – S1400I
For all patients on S1400I, the Adverse Events: Report form has been updated with the release of
Lung-MAP Revision #9/10 on 10/2/2017. Both retrospective and ongoing data collection regarding
immune-related adverse events (irAEs) will be required. On this form, please indicate if any irAEs
were seen during the cycle. Please also note the addition of the “CTEP-AERS report ticket number”
field for correlation with expedited SAE reporting, and the updated form instructions.
If “Yes” is selected as the response to the question “Were any adverse events seen in this reporting
period immune-related?”, for each adverse event listed in the cycle, please indicate “Yes” or “No” to
the “Is the AE immune-related?” field that generates.
If the adverse event warranted expedited
reporting via the CTEP-AERS system, please
enter the CTEP-AERS report ticket number
here. The grade and attribution of the event
should match the CTEP-AERS report.
If any AE’s in this reporting period were immune-related, this
question must be answered for all loglines. A separate
“Immune-Related Adverse Event” supplemental form will
generate for each adverse event term where this question is
answered “Yes”.
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S1400 Sub-study Forms
Immune-Related Adverse Event Form – S1400I
If “Yes” is selected as the response to the question “Is the AE immune-related?” for a specific
adverse event, a supplemental “Immune-Related Adverse Event” form will be generated for each
immune-related adverse event in the cycle. A separate form will need to be completed for each
immune-related adverse event.
Use “Add a new Log line” as needed to list multiple concomitant agents.
For concomitant agents administered for the treatment of immune-related AEs, please only list a
stop date within the corresponding cycle; if treatment was still ongoing at the end of the cycle, please
mark the “Ongoing” checkbox instead.
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S1400 Sub-study Forms
Site(s) of Progression or Relapse
This date should
match the date of the
scan demonstrating
progression.
This is disease status
at the primary lung
site, on the same side.
These are lymph
nodes, not nodules.
Check all that apply.
Any lesion that is
new, and not just
enlarged, should be
reported on the NEW
LESIONS section of
the Follow-up: Tumor
Assessment Form.
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S1400 Sub-study Forms
Off Treatment Notice
If they received even
one dose while on
protocol, this is ‘Yes’.
If off treatment for
more than one reason
(e.g. symptomatic
deterioration and
progression) record
the main reason the
patient came off
study. Explain in
comments.
If the patient came off treatment for:
Progression: enter the date of the scan that demonstrated progression
Positive biopsy that confirmed progression seen on a scan: enter the date of
the scan, not the date of the biopsy.
Toxicity or Patient Decision: enter the date the decision was made to remove
the patient from the protocol.
All toxicities continue to be collected until 30 days after the last dose of drug or
resolution to baseline.
Please note:
For patients on S1400I, serious AEs occurring within 100 days after last
administration of the protocol agents require expedited reporting.
For patients on S1400F, serious AEs occurring within 90 days after last
administration of the protocol agents require expedited reporting
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S1400 Sub-study Forms
Advanced NSCLC Follow-up Form
This can be from a
clinic visit or a test.
Please refer to section 14 of the sub-study protocol for the follow-up schedule.
This includes protocol
treatment that is
continued after off
treatment (e.g.
Docetaxel).
If the Off Treatment
Form indicated a
treatment that has
started during this
report period, report
yes.
If this form is being
completed at the time
of disease
progression, state yes.
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S1400 Sub-study Forms
Notice of Death Form
This form is due within 28 days of knowledge of death.
There must be a
source document in
the patient’s record
to support this date.
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S1400F & S1400K Sub-study Forms
Due to new clinical research data reporting requirements, S1400F & S1400K forms have many
features that are not found in other sub-study Rave forms. This section covers the these forms and
their data entry requirements.
Eligibility Criteria
This form contains the protocol section 5 eligibility criteria. A response must be provided for each
criterion listed; none should be left blank. An example from S1400F is provided in the screenshot
below.
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S1400F & S1400K Sub-study Forms
Onstudy: Patient and Disease Description
Onstudy: Laboratory Values - Baseline
Onstudy: Laboratory Values – Baseline
LLN, ULN, and Sample collection date are required for each lab value.
S1400F:
This is Free T3 & T4, not total T3 & T4.
If any of the data points on this form require clarification with additional comments, the comments must have the corresponding “question number” selected in the log line.
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S1400F & S1400K Sub-study Forms
Onstudy: Laboratory Values – Baseline
LLN, ULN, and Sample collection date are required for each lab value.
S1400K:
Please note these labs specific to S1400K
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S1400F & S1400K Sub-study Forms
Onstudy: Prior Treatment – Baseline
Examples of anti-PD-1 antibody monotherapy:
Pembrolizumab
Nivolumab
Examples of anti-PD-L1 antibody monotherapy:
Atezolizumab
Durvalumab
Avelumab
Please specify patient’s prior therapies by selecting the appropriate option in the drop-down box and typing in additional details in the adjacent text box as needed. Typing a response in the drop-down box field box will generate a non-conformant data error.
S1400F: At least one “Anti-PD-1 antibody monotherapy” and/or “Anti-PD-L1 antibody monotherapy” must be selected with additional information provided. See examples of potentially applicable monotherapy agents below.
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S1400F & S1400K Sub-study Forms
Treatment Form
S1400F:
Patient’s vital signs should be monitored before, during, and after the infusion and recorded on the appropriate cycle treatment form. This is required for every cycle. Times should be reported in a 24-hour format.
Note these fields asking for supplemental information regarding the infusion. Times should be reported in 24-hour format.
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S1400F & S1400K Sub-study Forms
Treatment Form
S1400K:
Record collection times for peripheral blood samples (for PK/ADA/nAB) on Cycles 1-4. Please note these samples should be logged in SWOG Specimen Tracking and shipped to Lab #201.
Note these fields asking for supplemental information regarding the infusion. Times should be reported in 24-hour format.
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S1400F & S1400K Sub-study Forms
Adverse Events: Report
- S1400F: Moving forward, all sub-studies that utilize immunotherapy agents will collect data
regarding immune-related adverse events. For each AE listed on the S1400F form, please
indicates “Yes” or “No” in the “Is the AE immune-related?” field. For each adverse event where
“Yes” in this field is selected, a new “Immune-Related Adverse Event” form will generate in the
cycle folder.
Only for S1400F
Required for S1400F and S1400K
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S1400F & S1400K Sub-study Forms
Adverse Events: Report (continued)
- Serious adverse events as defined in sub-study protocol section 16 should have “Yes” indicated
in the “Serious” field. Associated CTEP-AERS report ticket numbers should be added in the
corresponding field; please see section 16.0.e for instructions regarding SAE reporting.
- For S1400K, the post dosage expedited reporting requirement window is 30 days.
- For S1400F, the post dosage expedited reporting requirement window has been extended to 90
days rather than the normal 30 day requirement or until the initiation of alternative anticancer
therapy.
- Sub-study F has adverse events of special interest, and requires expedited reporting in CTEP-
AERS:
o Any Grade Diarrhea / Colitis
o Any Grade Pneumonitis / ILD
o Any Grade ALT/AST increases / hepatitis / hepatotoxicity
o Any Grade Neuropathy / neuromuscular toxicity (e.g., Guillain-Barré, and myasthenia
gravis)
o Any Grade Endocrinopathies (i.e., events of hypophysitis, hypopituitarism adrenal
insufficiency, diabetes insipidus, hyper- and hypothyroidism and type I diabetes mellitus)
o Any Grade Rash / Dermatitis
o Any Grade Nephritis / Blood creatinine increases
o Any Grade Pancreatitis (or labs suggestive of pancreatitis - increased serum lipase ,
increased serum amylase)
o Any Grade Other inflammatory responses that are rare with a potential immune-mediated
aetiology include, but are not limited to, myocarditis, pericarditis, and uveitis.
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S1400F & S1400K Sub-study Forms
Immune-Related Adverse Event
S1400F:
This form generates for every adverse event in the “Adverse Events: Report” form that is
indicated as immune-related.
Use “Add a new Log line” as needed to list multiple concomitant agents.
For concomitant agents administered for the treatment of immune-related AEs, please only list a
stop date within the corresponding cycle; if treatment was still ongoing at the end of the cycle, please
mark the “Ongoing” checkbox instead.
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S1400F & S1400K Sub-study Forms
End of Study Form
- Please only complete this form if the patient has gone off study, which is defined as:
o reaching or expiring prior to maximum protocol-defined follow-up of 3 years, or
o being documented as lost to follow-up per SWOG Policy #30, or
o patient withdrawal of consent to all protocol treatment and follow-up on the study, per
SWOG Policy #30.
- If the patient withdraws consent to all study follow-up, even after coming off protocol treatment,
please also complete the “Lost to Follow-Up” form in this patient’s Rave chart.
- This is not the same as removal from protocol treatment, which should be documented in the “Off
Treatment Notice.”