Subsequent Treatment For RCC

GSK Principal: Case Report Forms, Version 3.1 CONFIDENTIAL 31 of 38

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SITE ID PATIENT ID

1. Subsequent treatment name for RCC

2. Start date:Unknown

SUBSEQUENT TREATMENT FOR RCC LOG FORM

3. Stop date:Unknown

4. Dose: Licensed dose

Other, specify

5. Was the regimen of therapy discontinued? NoYes

5a. If yes, primary reason for discontinuation:

If discontinuation was because of an SAE, please be sure to fill out the SAE form

AxitinibIL-2 (e.g., Proleukin, Aldsleukin)Interferon-aBevacizumab (Avastin)EverolimusSorafenib (Nexavar)Sunitinib (Sutent)TemsirolimusOther

DD-MMM-YYYY, MMM-YYYY, YYYY

DD-MMM-YYYY, MMM-YYYY, YYYY

Patient deathDisease progressionPatient decisionLost to follow-upAdverse eventPre-surgical procedureOther, specify