Clinical Trial Submission Form

Please fill out the information below if you would like to post your clinical trial on our clinical trial page and to be shared on social media. Please make sure to use patient friendly language. Contact us at advocacy@cholangiocarcinoma.org for more information.

For a list of submitted clinical trials, visit our clinical trials page.

Study Name(Required)

ClinicalTrials.gov Identifier (if applicable)

Clinical Trial Category (check all that apply)(Required)

First Line Therapy

Beyond First Line Therapy

Chemotherapy

Targeted Therapy

Immunotherapy

Radiation Therapy

Other Novel Therapy

Study Center

Institution Name

Institution Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Website

List additional Institutions (include address, phone number, and website)

Study Contacts

Principal Investigator(Required)

P.I. Phone(Required)

P.I. Email(Required)

List additional Principal Investigators (include phone number and email)

Study Coordinator(Required)

Study Coordinator Phone(Required)

Study Coordinator Email(Required)

List additional Study Coordinators (include phone number and email)

OVERVIEW – in layman's terms (150 words max)

Enrollment(Required)

Study Start Date(Required)

Estimated Completion Date(Required)

Purpose of the Study – in Layman's Terms (use the "+" to add more list items)

Inclusion Criteria – Patients Must:

Exclusion Criteria – Patients Must NOT:

REQUIRED TESTS PRIOR TO BEGINNING STUDY TREATMENT – in layman’s terms

POTENTIAL SIDE-EFFECTS – in layman’s terms

Financial Assistance is available to participants for travel, lodging, etc.(Required)

Yes

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