Alkem

Patient ID *

Date of Birth *

Gender*

Male Female

Date of Cancer Diagnosis *

Cancer Type*

Colorectal Lung Glioblastoma Renal Cell Carcinoma Other

Stage of Disease at Diagnosis *

Performance Status (e.g., ECOG score) *

Date of Bevacizumab Initiation *

Initial Dosage (mg/kg) *

Frequency of Administration *

Bi- Weekly Once in 3 weeks Other

Specify chemotherapy regimen *

Duration of Bevacizumab Treatment *

Start Date *

End Date (if applicable)

Reason for Discontinuation (if applicable)

Adverse Event Lack of Efficacy Completion of Planned Treatment Patient Preference Other

Tumor Response (based on RECIST criteria) *

Complete Response (CR) Partial Response (PR) Stable Disease (SD) Progressive Disease (PD)

Start Date *

Initial Assessment *

Subsequent Assessments (specify dates and results) *

Progression-Free Survival (PFS) If Available

Date of Disease Progression

Overall Survival (OS) If available

Date of Last Follow-Up or Death *

Adverse Events (AEs) *

Date of Onset *

Description of AE *

Severity *

Mild Moderate Severe

Relationship to Bevacizumab *

Not Related Possibly Related Probably Related Definitely Related

Outcome *

Resolved Ongoing

Date of Study Completion for Patient *

Final Comments/Notes *