Alkem

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CET

Retrospective Evaluation of Biosimilar Cetuximab's Efficacy in Locoregionally Advanced or Recurrent Squamous Cell Carcinoma of the Head and Neck: A Multicenter Analysis.

Patient No *

Patient Initials *

Date of Enrollment *

Investigator * {{-- value="Dr. Vinay Shetty" readonly --}}

Site *

Date of visit *

Patient's name initials *

Age (in Years) *

Gender *

Male Female

Height (in cm) *

Weight (in Kg) *

PET scan report/CT scan report

Date of performed *

Diagnosis *

Locoregional advance Recurrent locoregional Metastatic

SCCHN *

Previous medications/ history *

Medical/surgical history *

Physical examination *

Vital sign

Blood pressure (%)

Heart rate (%)

Temperature (%)

Respiratory rate (%)

Cetuximab administration

Dose *

Time *

Date *

Any complication *

Yes No

Regimen/RT used with cetuximab *

TPX EXTREME CRT

Subsequent Visit

Cetuximab dosing *	Date of dose *	Dosage *	Any complication *

PET scan/ CT scan comments after treatment *

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