MAP chemotherapy regimen is used to treat osteosarcoma.

which drugs?

Methotrexate, Doxorubicin (Adriamycin) and cisPlatin

how is it given?

Into a vein (intravenously). This maybe through a cannula, central line or a PICC line. They are all given as a drip (infusion). You will also be given anti sickness drugs and lots of fluid in the drip.

how often is it given?

You’ll receive 6 cycles of chemo, each given over about 5 weeks – with surgery to remove your primary tumour after the first 2 cycles.

Each cycle of chemo is given in 2 parts. Each part involves being in hospital for a few days.

Day 1 is the first day of treatment.

• Part A (Doxorubicin and Cisplatin) Both drugs are given as a drip over 4 hours.With the cisplatin you’ll be given extra fluids in a drip (throughout your chemo and for about 12 hours afterwards).
• Day 1 - doxorubicin and cisplatin
• Day 2 - doxorubicin and cisplatin
• Day 3 - cisplatin

You’ll be in hospital for about 4 days for this part of your treatment.

• Part B (Methotrexate)
• Day 22 - methotrexate and fluids (you will be inhospital for 4-5 days). You can't go home until the level of methotrexate has fallen to a safe level. This is checked by a blood test each day
• Day 29 - methotrexate and fluids (again you will need to be in hospital for 4-5 days).

• Cycles 5 and 6 of your chemo
  For the last 2 cycles of your chemo you don’t need to have the cisplatin. This means you only need the doxorubicin part of the treatment which can be given over 2 days (so you only need to stay in hospital for one night).

what else?

There are two other drugs that can be used to treat osteosarcoma. They are ifosfamide and etoposide. They can be given as part of your standard treatment. Sometimes doctors give them when they feel there might be a higher chance of the cancer coming back (relapse).

are there any side effects?

Chemo can sometimes cause unpleasant side effects. These can usually be controlled with medicines. The main side effects are mentioned here. You can find out ways of coping with them by looking in our deal with it section.

• Lowered resistance to infections: Your immune system doesn’t work as well as it should when you’re having chemo so you might pick up more colds or infections. Sometimes drugs can be given to help blood cells recover quickly and boost your immune system
• Feeling sick: The drugs can cause nausea (feeling sick) but medicines are given to help prevent and control this
• Hair loss: Some drugs cause you to lose your hair (from your head and sometimes your body too – like eyelashes). If this happens, it will always grow back around 3-6 months after treatment stops
• Anaemia: You might have a low level of red blood cells (which carry oxygen around the body). This makes you feel tired, like you’ve got no energy. You might also feel a little out of breath
• Bruising and bleeding: Chemo can make you more prone to this so tell your doctors if you notice it
• Sore mouth: Some chemo can make this happen so keep an eye out for any little mouth ulcers or sore areas. Mouthwashes help prevent this. The nurses will explain what to do.

anything else I should know?

• Fertility: Treatment can also affect your fertility, that’s your ability to become pregnant or father a child. Blokes may need to consider sperm banking.
• Contraception: You really shouldn’t get pregnant or get someone pregnant while you’re having chemo. It’s important to use effective contraception during chemo and for a few months after. You can talk this over with your doctor or nurse for advice.
• Periods: For girls your periods may stop. This is usually a temporary effect of treatment and they will come back once treatment has finished, usually within a few months.
  

how will I feel?

Chemo affects everyone differently but it’s likely that you’ll feel rough at various times (and better at other times). You might also feel emotional and depressed or irritable. Some people find that it really helps to talk to someone close (or a counsellor).

You’ll probably find that your energy levels will vary and some days will be better than others. You can talk to your school or college about taking time off and maybe working from home some of the time.

Although you won’t feel up to doing everything you normally would do, there’s no need to stop your social life completely. You can still go out, meet friends and do things. It just might take a bit more planning ahead than normal. Explain to your friends that sometimes you won’t know until the day whether you’ll feel up meeting them.  And if you can’t make it, tell them to text or email you so that you can keep up with what’s happening.