Case Report Forms

Screening Registration Forms:

Screening Registration Form [pdf, 234 KB]
Cohort Allocation Form [pdf, 631 KB] (for Trial Office staff use only)

Paper CRFs:

Core Eligibility Checklist [pdf, 102 KB]
Eligibility Checklist – Arm B: Vistusertib (AZD2014) [pdf, 104 KB]
Eligibility Checklist – Arm C: Palbociclib [pdf, 99 KB]
Eligibility Checklist – Arm D: Crizotinib [pdf, 82 KB]
Eligibility Checklist – Arm E: Selumetinib & Docetaxel [pdf, 107 KB]
Eligibility Checklist – Arm J: AZD6738 & Durvalumab [pdf, 116 KB]
Registration Form [pdf, 61 KB] (For reference only)

eRDC CRFs:

Biopsy Collection Adverse Events Form [pdf, 115 KB]
Medical History Form [pdf, 150 KB]
Previous Cancer Treatment Form [pdf, 213 KB]
Adverse Event Form [pdf, 230 KB]
Concomitant Medication Form [pdf, 155 KB]
Concomitant Radiotherapy Form [pdf, 152 KB]
Arm A Laboratory Tests Form [pdf, 285 KB]
Arm B Laboratory Tests Form [pdf, 281 KB]
Arm C Laboratory Tests Form [pdf, 113 KB]
Arm D Laboratory Tests Form [pdf, 404 KB]
Arm E Laboratory Tests Form [pdf, 393 KB]
Arm F Laboratory Tests Form [pdf, 223 KB]
Arm G Laboratory Tests Form [pdf, 264 KB]
Arm H Laboratory Tests Form [pdf, 300 KB]
Arm J & NA Laboratory Tests Form [pdf, 128 KB]
Physical Exam Form [pdf, 234 KB]
Response Assessment [pdf, 247 KB]
Treatment Form [pdf, 90 KB]
Arm NA Cohort NA1 Treatment Form [pdf, 245 KB]
ECG Form [pdf, 128 KB]
Arm A – H Vital Signs Form [pdf, 249 KB]
Arm J & NA Vital Signs Form [pdf, 87 KB]
ECOG Form [pdf, 164 KB]
Arm A - Ophthalmology Exam Form [pdf, 244 KB]
Arm D - Ophthalmology Exam Form [pdf, 219 KB]
Arm E - Ophthalmology Exam Form [pdf, 250 KB]
Arm G Ophthalmology Exam Form [pdf, 238 KB]
ECHO/MUGA Form [pdf, 221 KB]
Post Treatment Survival Form [pdf, 166 KB]
Post Trial Cancer Treatment Form [pdf, 212 KB]
Pregnancy Notification Form [pdf, 256 KB]
Deviation Form [pdf, 173 KB]
Death Form [pdf, 209 KB]
Withdrawal of Consent Form [pdf, 171 KB]
Treatment Discontinuation Form [pdf, 63 KB]
Non-Treated Decision Form [pdf, 221 KB]