Request form for access to IMMUcan samples and or data

Request form for access to IMMUcan samples and/or data

Applicants are invited to submit additional documentation that may facilitate review (e.g. preliminary data or publications) of their proposal as supplementary appendices.
1. Identification
Title
Proposal request date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Requestor name

First NameLast Name
Requestor email
example@example.com
Institution where the research is conducted
Name and organisation of IMMUCAN consortium partner involved (if applicable)
What is the main scope of your project (Meta-analysis, translational research, statistical or methodological research, other)
Contact details (scientific leader)
Scientific leader name

First NameLast Name
Address
Telephone
Email
example@example.com
The newly enforced EU MDR and AI Act applies to processing software intended to provide information for: diagnosis, prevention, monitoring, treatment, or alleviation of a disease. It applies to software that provides a diagnosis or therapy by itself, but also to software that merely provides information intended to inform a medical professional in making the final diagnostic or therapeutic decision.
Does your research make use of or intend to develop a software that falls under EU Medical Device Regulation or Artificially Intelligence Regulation?
If yes, please clarify
Does your research qualify as non-commercial research?

Non-commercial research means that the research proposed:
- Does not aim to commercialise, or develop for commercialisation, including through clinical trials, any product or service, applications, AI tool, model or any other material that might be developed using the data and/or biological material;
- Does not intend to, and shall not, use the data and/or biological material for any registration purposes, regulatory filing or patent filing.
Non-commercial research
Please explain
What is the intended use of the research results (e.g. scientific publication, development, training and/or validation of a product or service, such as software applications/AI models/ algorithms/ technologies or devices, regulatory filing, patent filing, etc.)?
2. Project description and needs
Research question(s)
Abstract of research plan
Including background, objectives and if applicable, experimental techniques to be applied on the samples i.e. sequencing, IHC (max 300 words)
Analysis plan
including statistical method if applicable
Does the proposal require the use of biological material from the IMMUcan biobank ?
HBM Notes
- for FFPE block : Assessed leftover quantity=20 µm, FFPE unstained slides/scrolls request is preferred over FFPE blocks request.
- Timepoints
  - Registration samples were collected for all cohorts
  - Progression samples were collected exclusively for the following cohorts: BC1, NSCLC, RCC, H&N cohort 1
  - Surgery samples were collected exclusively for BC2 and BC3 cohorts
Samples per patient
Does the proposal require the use of the clinical data collected in IMMUcan ?
If yes, list the variables requested:
Does the proposal require the use of molecular/cellular data ?
If yes, specify the type of molecular/cellular data
3. Project implementation details
Timelines: what are the expected timelines of the project ?
Timelines for the data analysis

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Timelines for the first publication of results

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Timelines for the expected project completion date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Have you already obtained the ethical committee positive opinion for this project ?
Please attach all documents that were sent/required to your EC as well the positive opinion document itself.

Cancelof
If you consider it is not applicable, please justify below
Source of fundings
Please note that a financial contribution can be requested.
Note that a Data and Material Transfer Agreement between the EORTC and the applicant’s institution may be required.
Authorship (for the IMMUCAN representatives)
By default, the IMMUcan/IMI consortium will need to be acknowledged. No automatic authorship positions are claimed on papers resulting from your research unless IMMUcan partners are contributing to it. If one or several positions should be attributed to IMMUcan members, please indicate them below:
Planned exploitation and ownership of intellectual property rights of research results (if applicable)
4. Privacy requirements
As of May 25, 2018, the General Data Protection Regulation (GDPR) has been in force, enhancing and reinforcing privacy protection across the European Union. While the core principles remain consistent with previous legislation, the GDPR introduces several new emphases and requirements to strengthen data protection. Under EU law, the processing of sensitive data (such as health data) on a large scale mandates the completion of a Data Protection Impact Assessment (DPIA). Given that the data you have requested are governed by EU regulations, you will assume the role of Data Controller for the data used in your Research Project. It is crucial that your Data Protection Officer (DPO) is actively involved in the design and implementation of your research plan. This involvement is essential to ensure compliance with privacy and data protection requirements associated with the processing of personal data in your Research Project. The primary goal is to achieve a pragmatic balance between minimizing the risk of re-identification and maintaining the utility of the data. To ensure adherence to these standards, please provide the following acknowledgments.
Description of the third parties involved in your research (agreements and roles)
Please, provide any additional information or specific details that may be relevant:
Description of the Data Transfers outside EU
Please, provide any additional information or specific details that may be relevant:
Description of context related Transparency

We are committed to providing patients with the necessary level of information on how their personal data is protected in an accessible and understandable format, in accordance with our responsibilities as Data Controller. To ensure transparency, we utilize specific channels to communicate this information effectively. These channels include Separate Privacy Notices that explain our role as Data Controller, the purposes for which their data will be used, and the measures we have in place to protect their personal information; Website References where patients can find comprehensive information about our data protection practices in our privacy policy available on our website. This policy clarifies our role as Data Controller for our research projects and outlines the purposes for which the acquired data will be used.
Please, provide any additional information or specific details that may be relevant
Description of measures taken to ensure Purpose Limitation
Please, provide any additional information or specific details that may be relevant
Description of measures taken to ensure Data Minimization
Please, provide any additional information or specific details that may be relevant
Description of Data Protection Impact Assessment (DPIA)
For more information, please refer to the Data Protection Impact Assessment (DPIA) webpage of the European Union.
Please, provide any additional information or specific details that may be relevant
Description of measures taken to ensure data security

We have put in place the necessary technical and organizational measures to protect the requested data (such as but not limited to due diligence and due security measures to protect information in coherent and effective manner by aligning or adhering to framework such as ISO27001, NIST 800 series etc, or controlled access to health and genetic data, mechanisms to prevent unauthorized disclosure, privacy exhibit up to date, etc).
Please, provide any additional information or specific details that may be relevant
Signature
By submitting this form, your signature confirms and acknowledges compliance with the EORTC Policy on Data Sharing, Collection and Use of Human biological material (if applicable) and all obligations and legal requirements defined in the Terms of Use (including the payment of the administrative fee and your responsibilities as a Data Controller in the scope of the presented project).

Terms of Use

All are available from: Policies - EORTC
Terms of use approval
Full name
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Request form for access to IMMUcan samples and/or data

1. Identification

Contact details (scientific leader)

2. Project description and needs

HBM Notes

3. Project implementation details

Timelines: what are the expected timelines of the project ?

4. Privacy requirements

Signature