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vNKT clinical trial · patient screening form
We are conducting a clinical study on vNKT immunotherapy. This form is for preliminary screening only; saving it does not mean enrollment. Information is used for screening only; separate informed consent will be signed before formal enrollment.
Part 1: Basic information
2. Sex
years
4. Nationality
Part 2: Disease and medical history
9. Treatments received (multiple choice)
10. Performance status (ECOG reference)
Part 3: Initial screening criteria
11. Are you 18 years of age or older?
12. Are you willing to participate and able to sign informed consent?
13. Known severe allergy, especially to biological products or monoclonal antibodies?
14. Active, uncontrolled severe infection (e.g. HBV, HCV, HIV, syphilis)?
15. Severe uncontrolled cardiac disease (e.g. NYHA III–IV), lung disease, or other major organ dysfunction?
16. Active autoimmune disease or need for systemic immunosuppression?
17. Pregnant or breastfeeding?
18. Participated in another drug or device trial within the past 6 months?
Part 4: Self-report and additional information
20. What do you hope to achieve through this immunotherapy study? (multiple choice)
Tip: For extensive records, you may contact the clinical study coordinator to submit pathology, imaging, or discharge summaries.
Declaration
肠癌
"Anti-cancer Special Force vNKT" is emerging as a rising star in China's immunology community.