MAP

MAP is a chemotherapy drug combination. It includes the drugs we list below, next to each drug we have how you pronounce the drug name in brackets.

• M - methotrexate (meth-oh-treks-ayt)
• A - doxorubicin - also called Adriamycin (doks-oh-roo-bi-sin)
• P - cisplatin (sis-pla-tin)

It is a treatment for a type of primary bone cancer called osteosarcoma.

How does MAP work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have MAP?

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have MAP?

You have MAP as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover. You usually have 6 cycles of treatment, 2 before surgery and 4 after surgery.

Each cycle of treatment lasts 35 days (5 weeks).

You have MAP in the following way:

Folinic acid and GCSF

You will have a drug called folinic acid 24 hours after starting methotrexate. It protects you against the side effects of methotrexate. You usually have it every 6 hours until your blood levels of methotrexate drop to a safe level. If your methotrexate levels are very high, you might have it every 3 hours.

Sometimes you might need another drug called GCSF after doxorubicin and cisplatin. It helps the bone marrow to make more white blood cells.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of MAP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills.

Allergic reactions can sometimes be life threatening. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Changes in levels of minerals in your blood

You may have changes in the levels of minerals in your blood. It’s common to have low levels of sodium. Rarely, you might have low levels of magnesium in your blood.

You'll have regular blood tests during treatment to check this.

Inflammation and ulcers in different parts of the body

It’s common to get a sore mouth and mouth ulcers. This can make it painful to swallow drinks or food. Ask your healthcare team for painkillers to help reduce the soreness. Take them half an hour before meals to make eating easier. You will have mouthwashes to keep your mouth healthy.

Other areas of the body that can be affected by inflammation and ulcers include the vagina, back passage (rectum) and food pipe (oesophagus), but this is less common. Rarely you might have ulcers in the large bowel (colon) or inflammation of the small bowel.

Tummy (abdominal) cramps

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Kidney changes

You might have some changes in the way your kidneys work. You have regular blood tests to check how well they are working.

Rarely, you might have changes such as your kidneys stopping working. Or you might pass little or no urine. You'll have regular blood tests to check how well they are working.

Pink or red urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• heart problems such as changes to the heart muscle or rhythm - tests such as a heart trace (ECG) might pick this up. Rarely, this treatment can cause a heart attack

• low blood pressure - symptoms might include feeling dizzy, sick, confused, feeling weak and tired

• diarrhoea

• hair loss

• skin changes such as darkening, a rash, redness, itching, or a rash with fever and feeling unwell

• inflammation of the bladder- symptoms include frequent or urgent need to pass urine, it can be painful, and you might pass blood

• headaches

• dizziness

• feeling drowsy

• changes to your lung tissue causing difficulty breathing, a dry cough and fatigue. Rarely there might be pain and thickening of the layer of tissue that covers the lung

• changes to how the liver works – rarely it can cause scarring (cirrhosis), fattening or liver failure. You have regular tests to check on how well your liver working

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• bleeding from the stomach – you might have dark, smelly poo or blood in your vomit. Contact your helpline immediately if you notice this

• inflammation of the pancreas causing symptoms such as tummy pain, feeling or being sick, loose watery poo and a high temperature

• darkening of the skin in an area of previous radiotherapy or skin sensitivity to sunlight

• dark or loose nails

• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

• wounds that are slow to heal

• seizures (fits), weakness or inability to move on one side, confusion, problems with movement, feeling sluggish or fatigued, problems with thinking

• a second cancer such as acute leukaemia or lymphoma

• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this

• eye problems such as an conjunctivitis – the eye may feel gritty, itchy, sticky from pus, watery and look red. Or you might have vision changes such as blurred vision, temporary loss of vision, or your eyes might be sensitive to light

• thickening and hardening of veins

• loss of body fluid (dehydration)

• high blood sugar levels (diabetes)

• mood changes and feeling very low (depression)

• inflammation of blood vessels

• muscle or joint pain

• weakening of the bones (osteoporosis)

• periods changing

• loss of sex drive, or loss of ability to get an erection

• vaginal discharge

• breast swelling

• numbness and tingling in the feet or hands

• hearing or balance problems

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.