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| Name | Class |
|---|---|
| Bayer | INDUSTRY |
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This is a phase IIa, open label, single arm, and prospective study of hormone therapy-naïve men with oligometastatic prostate cancer to the bone. The study will test if treating the primary tumor sites and 5 or fewer sites of bone-only metastasis with external beam radiation with concomitant systemic Radium-223 will reduce the utilization of androgen deprivation therapy, improve QOL and improve OS over a the comparator cohort of SWOG intermittent ADT historic cohort.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Radium Ra 223 dichloride and radiation, all patients | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Radium Ra 223 Dichloride | Drug | Radium Ra 223 dichloride will be delivered intravenously at 55 kBq/kg (1.49 mCi)/kg (+/- 10% total dose) for a total of six cycles. 1 cycle= 28 days. The first cycle will commence at study enrollment, then cycles 2-6 will commence after the completion of radiotherapies at 4 week intervals |
| Measure | Description | Time Frame |
|---|---|---|
| Count of Participants Requiring Androgen Deprivation Therapy (ADT) Use at 15 Months | To determine if 20% of ADT naïve men treated with concurrent EBRT and Radium-223 will not require ADT for progression by 15 months. | 15 months |
| Measure | Description | Time Frame |
|---|---|---|
| Median Time From Start of Study Therapy to Start of ADT | Determine the hormone-therapy free survival time for men treated with concurrent EBRT and Radium-223 and determine if it is a 30% risk reduction over the SWOG intermittent ADT historic cohort | 2 years |
| Mean Expanded Prostate Inventory Composite (EPIC) Scores at End of Treatment |
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Inclusion Criteria:
Asymptomatic or symptomatic hormone naïve men with testosterone levels ≥100 ng/dL with previously treated localized prostate cancer who now have rising PSA's and five or fewer bone metastases.
Subjects who have been previously treated with definitive and/or adjuvant/salvage radiotherapy to the primary site and/or regional lymph nodes with concurrent ADT are allowed if the last hormone therapy delivered > 6 months prior. Subjects who have had more than 30 days and fewer than 45 days of bicalutamide monotherapy for any reason within the 6 months prior to enrollment are eligible for the study, providing they have been off of the drug for at least 30 days prior to enrollment. Subjects who have had fewer than 30 days of bicalutamide are eligible for the study, as long as they discontinue the drug at least 5 days prior to the first study treatment.
Histologic confirmation of Prostate Adenocarcinoma diagnosis.
Age ≥ 18 years.
Life expectancy of at least 2 years.
Acceptable hematology and serum biochemistry screening values:
Willing and able to comply with the protocol, including follow-up visits and examinations.
Karnofsky Performance Score >60 or ECOG equivalent.
Radiographic confirmation of oligometastatic diagnosis via Bone Scan validated by either CT scan or MRI or PET/CT with Fluciclovine within the past 90 days.
Subjects who have not had surgical removal of their prostate and have a partner of child bearing potential must agree to use condoms beginning at the signing of the ICF until at least 6 months after the last dose of study drug. Because of the potential side effect on spermatogenesis associated with radiation, female partners of childbearing potential must agree to use a highly effective contraceptive method during and for 6 months after completing treatment
Able to provide informed consent and willing to sign an approved consent form that conforms to federal and institutional guidelines.
Exclusion Criteria:
Men with known brain or visceral metastases (except regional lymph nodes as defined by section 5.2.5) defined by CT or MRI Imaging of the abdomen or pelvis.
Men who have had LHRH agonist or antagonist hormone therapy in the prior six months.
Men with >5 bony metastases.
Men with baseline serum Testosterone <100 ng/dL.
Men with new or progressing lymphadenopathy clearly consistent with prostate metastasis on imaging or proven by pathologic biopsy at any time three months or later following their initial definitive therapy.
Prior or concurrent invasive malignancy (except non-melanomatous skin cancer) or lymphomatous/hematogenous malignancy unless continually disease free for a minimum of 3 years. All patients with in situ carcinoma are eligible for this study (for example, carcinoma in situ of the oral cavity is eligible) except patients with carcinoma of the bladder (including in situ bladder cancer or superficial bladder cancer).
Use of finasteride within 30 days prior to therapy PSA should not be obtained prior to 30 days after stopping finasteride.
Use of dutasteride within 90 days prior to therapy. PSA should not be obtained prior to 90 days after stopping dutasteride.
Previous or concurrent cytotoxic chemotherapy for prostate cancer.
Received systemic therapy with radionuclides (e.g., strontium-89, samarium-153, rhenium-186, or rhenium-188, or Radium Ra 223 dichloride) for the treatment of bony metastases.
Men who will receive radical prostatectomy to the primary site.
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI). Spinal Cord compression will be defined as 360 degree circumferential obliteration of T2 cerebrospinal fluid signal around the spinal cord. Treatment should be completed for spinal cord compression.
Severe, active co-morbidity, defined as follows:
Cardiac failure New York Heart Association (NYHA) III or IV Crohn's disease or ulcerative colitis.
Bone marrow dysplasia.
Fecal incontinence.
Any condition which, in the investigator's opinion, makes the subject unsuitable for trial participation.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Huntsman Cancer Institute | Salt Lake City | Utah | 84112 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Radium Ra 223 Dichloride and Radiation, All Patients | Radium Ra 223 Dichloride: Radium Ra 223 dichloride will be delivered intravenously at 55 kBq/kg (1.49 mCi)/kg (+/- 10% total dose) for a total of six cycles. 1 cycle= 28 days. The first cycle will commence at study enrollment, then cycles 2-6 will commence after the completion of radiotherapies at 4 week intervals Radiation: All external beam radiations oligometastatic sites will commence after cycle 1 of Radium-223 but prior to cycle 2 of Radium-223. All subjects will receive Stereotactic body or hypofractionated radiation to sites of bone disease seen on imaging studies. Patients will have the primary tumor sites and 5 or fewer sites of bone-only metastasis treated with external beam radiation. Any of the following regimens are considered ablative, acceptable and are biologically equivalent to 60Gy EQD2:
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| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Radium Ra 223 Dichloride and Radiation, All Patients | Radium Ra 223 Dichloride: Radium Ra 223 dichloride will be delivered intravenously at 55 kBq/kg (1.49 mCi)/kg (+/- 10% total dose) for a total of six cycles. 1 cycle= 28 days. The first cycle will commence at study enrollment, then cycles 2-6 will commence after the completion of radiotherapies at 4 week intervals Radiation: All external beam radiations oligometastatic sites will commence after cycle 1 of Radium-223 but prior to cycle 2 of Radium-223. All subjects will receive Stereotactic body or hypofractionated radiation to sites of bone disease seen on imaging studies. Patients will have the primary tumor sites and 5 or fewer sites of bone-only metastasis treated with external beam radiation. Any of the following regimens are considered ablative, acceptable and are biologically equivalent to 60Gy EQD2:
|
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Count of Participants Requiring Androgen Deprivation Therapy (ADT) Use at 15 Months | To determine if 20% of ADT naïve men treated with concurrent EBRT and Radium-223 will not require ADT for progression by 15 months. | Posted | Count of Participants | Participants | 15 months |
|
The collection of all adverse events will begin after the first dose of study treatment and end 30 days after the last dose of study treatment. The collection of treatment-related adverse events will continue until the last study visit (or until new cancer treatment is initiated, if sooner).
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Radium Ra 223 Dichloride and Radiation, All Patients | Radium Ra 223 Dichloride: Radium Ra 223 dichloride will be delivered intravenously at 55 kBq/kg (1.49 mCi)/kg (+/- 10% total dose) for a total of six cycles. 1 cycle= 28 days. The first cycle will commence at study enrollment, then cycles 2-6 will commence after the completion of radiotherapies at 4 week intervals Radiation: All external beam radiations oligometastatic sites will commence after cycle 1 of Radium-223 but prior to cycle 2 of Radium-223. All subjects will receive Stereotactic body or hypofractionated radiation to sites of bone disease seen on imaging studies. Patients will have the primary tumor sites and 5 or fewer sites of bone-only metastasis treated with external beam radiation. Any of the following regimens are considered ablative, acceptable and are biologically equivalent to 60Gy EQD2:
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Bone pain | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal pain | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Clinicaltrials.gov and CTRP Specialist | Huntsman Cancer Institute/University of Utah | 8012136215 | IITDataManagement@hci.utah.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 8, 2021 | Sep 26, 2023 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Aug 30, 2022 | Jan 22, 2024 | ICF_004.pdf |
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| ID | Term |
|---|---|
| C581106 | radium Ra 223 dichloride |
| D011827 | Radiation |
| ID | Term |
|---|---|
| D055585 | Physical Phenomena |
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This is a phase IIa, open label, single arm, prospective study
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| Radiation | Radiation | All external beam radiations oligometastatic sites will commence after cycle 1 of Radium-223 but prior to cycle 2 of Radium-223. All subjects will receive Stereotactic body or hypofractionated radiation to sites of bone disease seen on imaging studies. Patients will have the primary tumor sites and 5 or fewer sites of bone-only metastasis treated with external beam radiation. Any of the following regimens are considered ablative, acceptable and are biologically equivalent to 60Gy EQD2:
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To evaluate health related quality of life (QOL) as scored by the 50 item Expanded Prostate Inventory Composite (EPIC) EPIC urinary, bowel, sexual and hormonal domains. EPIC assesses the disease-specific aspects of prostate cancer and its therapies and comprises four summary domains (Urinary, Bowel, Sexual and Hormonal). Response options for each EPIC item form a Likert scale, and multi-item scale scores are transformed linearly to a 0-100 scale, with higher scores representing better health-related quality of life. |
| 6 months |
| Mean PROMIS-29 Scores at End of Treatment | To evaluate health related quality of life (QOL). The PROMIS-29 (Patient-Reported Outcomes Measurement Information System) will be used to assess general function and well-being. The raw score for each PROMIS instrument is converted to a T-score on a scale of 0-100. For most PROMIS instruments, a score of 50 is the average for the United States general population with a standard deviation of 10. A higher PROMIS T score represents more of the concept being measured. For negatively worded concepts like Anxiety, a T score of 60 is one SD worse than average. By comparison, an Anxiety T score of 40 is one SD better than average. However, for positively worded concepts like Physical Function Mobility, a T score of 60 is one SD better than average while a T score of 40 is one SD worse than average. | 6 months |
| Evaluate Time to First Skeletal Related Event (SRE) | Documentation of complications associated with bone metastases and may include (but not limited to) fractures, spinal cord compression, bone pain, and hypercalcemia. | 2 years |
| Evaluate the PSA Doubling Time | This outcome measure will report the mean time elapsed from baseline PSA to PSA to double in value. Participants were followed for 24 months from the initiation of study treatment. PSA doubling time was censored at 24 months. | 2 years, assessed at every visit in that time period |
| Evaluate Overall Surival | This outcome measure will report the overall survival at 2 years. Patients were followed for survival for two years after study enrollment. Patients who refused follow-up were censored at their off-study date. | 2 years after study enrollment |
| Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Secondary | Median Time From Start of Study Therapy to Start of ADT | Determine the hormone-therapy free survival time for men treated with concurrent EBRT and Radium-223 and determine if it is a 30% risk reduction over the SWOG intermittent ADT historic cohort | 8 of 20 total patients did not begin ADT while on study, so 12 of 20 patients were evaluated for this measure | Posted | Median | Standard Deviation | Days | 2 years |
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|
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| Secondary | Mean Expanded Prostate Inventory Composite (EPIC) Scores at End of Treatment | To evaluate health related quality of life (QOL) as scored by the 50 item Expanded Prostate Inventory Composite (EPIC) EPIC urinary, bowel, sexual and hormonal domains. EPIC assesses the disease-specific aspects of prostate cancer and its therapies and comprises four summary domains (Urinary, Bowel, Sexual and Hormonal). Response options for each EPIC item form a Likert scale, and multi-item scale scores are transformed linearly to a 0-100 scale, with higher scores representing better health-related quality of life. | Of the 20 total participants, 10 completed the EPIC questionnaire at the End of Treatment timepoint | Posted | Mean | Standard Deviation | score on a scale | 6 months |
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|
|
| Secondary | Mean PROMIS-29 Scores at End of Treatment | To evaluate health related quality of life (QOL). The PROMIS-29 (Patient-Reported Outcomes Measurement Information System) will be used to assess general function and well-being. The raw score for each PROMIS instrument is converted to a T-score on a scale of 0-100. For most PROMIS instruments, a score of 50 is the average for the United States general population with a standard deviation of 10. A higher PROMIS T score represents more of the concept being measured. For negatively worded concepts like Anxiety, a T score of 60 is one SD worse than average. By comparison, an Anxiety T score of 40 is one SD better than average. However, for positively worded concepts like Physical Function Mobility, a T score of 60 is one SD better than average while a T score of 40 is one SD worse than average. | Of the 20 total participants, 10 completed the EPIC questionnaire at the End of Treatment timepoint | Posted | Mean | Standard Deviation | T-scores | 6 months |
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| Secondary | Evaluate Time to First Skeletal Related Event (SRE) | Documentation of complications associated with bone metastases and may include (but not limited to) fractures, spinal cord compression, bone pain, and hypercalcemia. | Of 20 evaluable participants, two experienced a skeletal related event. | Posted | Mean | Standard Deviation | Days | 2 years |
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| Secondary | Evaluate the PSA Doubling Time | This outcome measure will report the mean time elapsed from baseline PSA to PSA to double in value. Participants were followed for 24 months from the initiation of study treatment. PSA doubling time was censored at 24 months. | Posted | Mean | Standard Deviation | months | 2 years, assessed at every visit in that time period |
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| Secondary | Evaluate Overall Surival | This outcome measure will report the overall survival at 2 years. Patients were followed for survival for two years after study enrollment. Patients who refused follow-up were censored at their off-study date. | Posted | Mean | Standard Deviation | month | 2 years after study enrollment |
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| 0 |
| 20 |
| 1 |
| 20 |
| 20 |
| 20 |
| Fracture | Injury, poisoning and procedural complications | CTCAE (4.0) | Non-systematic Assessment |
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| Alopecia | Skin and subcutaneous tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Anemia | Blood and lymphatic system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Anorexia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Back pain | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Bloating | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Bone pain | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cardiac disorders - Other, specify | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Chest wall pain | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cognitive disturbance | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Constipation | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cough | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Diarrhea | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Dizziness | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Edema limbs | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Epistaxis | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Esophagitis | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Fatigue | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Flu like symptoms | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Fracture | Injury, poisoning and procedural complications | CTCAE (4.0) | Non-systematic Assessment |
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| Headache | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hematuria | Renal and urinary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hyperglycemia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hypertension | Vascular disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hyponatremia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Lymphocyte count decreased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Musculoskeletal and connective tissue disorder - Other, specify | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Nausea | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Neck pain | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Pain | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Pain in extremity | Musculoskeletal and connective tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Paresthesia | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Pelvic pain | Reproductive system and breast disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Peripheral sensory neuropathy | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Platelet count decreased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Presyncope | Nervous system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Renal and urinary disorders - Other, specify | Renal and urinary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Respiratory, thoracic and mediastinal disorders - Other, specify | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Skin and subcutaneous tissue disorders - Other, specify | Skin and subcutaneous tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Surgical and medical procedures - Other, specify | Surgical and medical procedures | CTCAE (4.0) | Non-systematic Assessment |
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| Tinnitus | Ear and labyrinth disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Urinary incontinence | Renal and urinary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Urinary urgency | Renal and urinary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Vertigo | Ear and labyrinth disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Weight loss | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| White blood cell decreased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Title | Measurements |
|---|---|
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| Hormonal Summary Score |
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| Title | Measurements |
|---|---|
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| Fatigue |
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| Anxiety/Fear |
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| Sleep Disturbance |
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| Satisfaction with Social Roles and Activities |
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