MEDICAL RECORD 
CONTINUATION SHEET for either: 
NIH 2514*1, Consent to Participate In A Clinical Research Study 
NIH 2514-2, Minor Patient’s Assent to Participate In A Clinical Research Study 
STUDY NUMBER: 
CONTINUATION: page _JL of -—-pages. 
You could also consider receiving other experimental treatments such as 
experimental chemotherapy. The option also exists to receive no treatment at 
this time. 
Follow-Up 
After you receive each cycle of this procedure you will be discharged 
from the hospital. At about five weeks after the last treatment you will be 
required to return to the NIH for follow-up studies. Tests used to decide if 
your tumor has responded to the procedure will be similar to those you had 
before beginning the therapy. 
When you have completed your participation in this study, you will be 
eligible to be considered for participation in other research protocols at the 
National Cancer Institute and you will receive care as indicated by your 
disease or you will be referred elsewhere for care. 
As this is a new procedure, side effects that may cause your condition to 
deteriorate may be encountered. You will be watched closely for any side 
effects . 
You are free to withdraw your consent to participate in this study at the 
National Cancer Institute and seek care from any physician at any time. If 
you withdraw from the study after the injection of the gene-modified tumor 
cells but before the surgical excision of the injection site, then we would be 
willing to immediately resect the injection site or observe the injection site 
at monthly intervals and resect the site if tumor appears. 
If you have any questions concerning issue of patients rights you can 
contact Ms. Betty Schwerinq . phone # 496-2626, in the Clinical Center, NIH. 
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