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! 
10. I have been informed that should I suffer any injury as a result of participation in this 
research activity, reasonable medical facilities are available at this institution. 1 understand, 
however, that I cannot expect to receive any financial compensation from this institution for such 
injury. 
1 1 . 1 understand that I will not be charged for any procedure or test of an investigational nature. 
The drugs and immune cells will also be provided free of charge. The specially engineered 
mouse viruses will be provided at no charge by Genetic Therapy, Inc. of Gaithersberg, MD. 
I understand that I may discuss this and ask any questions regarding billing before I consent to 
treatment. 
12. 1 understand that cells obtained from my blood or tumor may be used to establish a cell line 
which may be shared in the future with other researchers and which may be of commercial value. 
A cell line is one which will grow indefinitely in the laboratory. Cell lines may be useful 
because of the characteristics of the cells and/or products they may produce. 
13. The study and its procedures have been explained to me by . I 
understand that if 1 have any questions, I may contact Dr. James Economou (310-825-2644) or 
Dr. Arie Belldegrun (310-206-1434) in the Department of Surgery, UCLA Medical Center. 
They will answer any questions at any time regarding any aspect of this study. If the study 
design or the use of the information is to be changed, I will be so informed and my consent will 
be reobtained. 
14. 1 understand that the possible benefit of this study is the stimulation of the immune response 
and potential shrinkage of my tumor. Although these treatments may be helpful, these are 
experimental treatments and therefore it is not possible to determine the likelihood of benefit at 
this time. I understand that my tumor may progress and my condition may become worse in 
spite of receiving this experimental treatment. 
i 
I understand that if I am injured as a direct result of research procedures not done primarily for 
my own benefit I will receive medical treatment at no cost. The University of California does 
not provide any other form of compensation for injury. 
HSPC #91-10-442 
Date of expiration 
Recombinant DNA Research, Volume 15 
[563] 
