MAP Regimen

The MAP regimen is a standard chemotherapy protocol for osteosarcoma (high-grade bone sarcoma, usually in children, adolescents, and young adults).

Components of MAP

• M = Methotrexate (high-dose MTX with leucovorin rescue)
• A = Adriamycin (Doxorubicin)
• P = Platinum (Cisplatin)

Indications

• High-grade osteosarcoma (localized or metastatic)
• Often given in neoadjuvant setting (before surgery) → then adjuvant cycles post-surgery.
• Used in pediatric, adolescent, and young adult patients (standard of care).

Typical Schedule (Children’s Oncology Group / EURAMOS-1 trial)

• Pre-operative (neoadjuvant):
  • High-dose methotrexate (12 g/m² IV) weekly × several doses
  • Cisplatin (120 mg/m² IV, day 1) + Doxorubicin (75 mg/m² IV, days 1–2) every 3 weeks
• Surgery (resection of primary tumor ± metastases)
• Post-operative (adjuvant):
  • Repeat cycles of MAP (total duration usually 6–9 months)

(Exact dosing varies by protocol, age, and institution — pediatric vs adult dosing is adjusted carefully.)

Toxicities

• Methotrexate (HD-MTX): nephrotoxicity, hepatotoxicity, mucositis, neurotoxicity, delayed clearance (requires leucovorin rescue + hydration/alkalinization).
• Doxorubicin: cardiotoxicity (cumulative dose-dependent), myelosuppression, alopecia.
• Cisplatin: nephrotoxicity, ototoxicity, neurotoxicity (peripheral neuropathy), severe nausea/vomiting.

Monitoring

• MTX serum levels + renal function (to guide leucovorin rescue).
• Cardiac monitoring (ECHO/MUGA) for doxorubicin.
• Renal and audiology tests for cisplatin.
• CBC for myelosuppression.

Summary for oncology pharmacist:

The MAP regimen (Methotrexate + Adriamycin [doxorubicin] + Cisplatin) is the backbone of curative chemotherapy for osteosarcoma. It is used both pre- and post-surgery to maximize tumor shrinkage and eradicate micrometastatic disease, but requires intensive monitoring for renal, cardiac, and auditory toxicities.