MAP
MAP, a combination consisting of the chemotherapy drugs methotrexate, doxorubicin, and cisplatin, is employed for treating osteosarcoma, a form of primary bone cancer. Understanding the intricacies of this treatment, including its administration, potential side effects, and precautionary measures, is essential for patients to actively engage in their care and enhance treatment outcomes. Download the MAP protocol for further information.
Administration
• Administered intravenously (IV, meaning through the veins), typically in a hospital setting or chemotherapy day unit.
• Different delivery methods, including cannulas, central lines, PICC lines, or implantable ports, are tailored to individual patient needs.
• Doxorubicin and Cisplatin are administered in week 1, while high dose Methotrexate is administered on weeks 4 and 5. The cycle is repeated every 5 weeks.
• Cisplatin and Doxorubicin are administered over 2-3 days. High dose Methotrexate is administered over 1 day followed by careful monitoring and hydration over a week.
• A multidisciplinary team, including a cancer doctor, chemotherapy nurse, and specialist pharmacist, oversees the administration.
• Before treatment, a blood sample is taken to ensure safe blood cell levels for chemotherapy.
• You may receive oral or IV drugs prior and after the infusion to prevent nausea.
• Folinic acid, a drug also known as leucovorin or calcium folinate, is occasionally administered following methotrexate treatment, particularly with higher doses, to alleviate its side effects.
• It is possible that a subcutaneous injection is required following each cycle. Given at home or at the clinic, it will help boost the immune system.
• Imaging is usually repeated every 2-3 cycles to determine the response.
• The number of cycles of treatment will depend on your tolerance to treatment and your response.
Potential Side Effects & Management
While treatment is being given:
• Allergic Reactions: Rapid onset of symptoms like flushing, itching, or swelling requires immediate attention due to sarcoma patients’ specific vulnerability.
• Extravasation: Drug leakage outside the vein is critical for sarcoma patients. It can impact surrounding tissues, warranting urgent intervention.
• Pain along the vein: If you feel pain, ask your nurse to check the site. The drug can be diluted or administered more slowly to reduce the pain.
• Facial Flushing: Temporary but may be more pronounced in certain patients due to drug interaction.
Common Side Effects:
• Infection Risk: Given sarcoma treatments’ intensity, reduced white blood cell counts heighten infection risks, necessitating vigilance and timely medical intervention. If you have a fever over 38.3°C, you should advise your medical team or go to the emergency department.
• Bruising and Bleeding: Reduced platelets due to treatment can lead to easy bruising, nosebleeds, or blood in urine/stool. Platelet transfusion might be necessary.
• Anemia: Reduced red blood cells due to treatment can cause anemia. If severe, blood transfusion might be necessary.
• Nausea, Vomiting and Hair Loss: Managing these side effects can significantly impact quality of life during treatment.
• Sore Mouth & Throat: Treatment may cause sore mouth and throat which can potentially lead to mouth ulcers and increased risk of infection. Maintain oral hygiene; contact your healthcare team for mouthwash or medicines if needed.
• Diarrhea: Increased bowel activity; more common if you have a stoma.
• Loss of Appetite: Treatment can impact appetite temporarily. Dietary changes may be suggested.
• Skin Changes: Rash, sensitivity, discoloration; moisturizing and protective measures are recommended.
• Sore and Red Palms, Soles: Palmar-plantar syndrome causes redness and peeling. Keep hands and feet cool, moisturize, and avoid tight-fitting items.
• Nail Changes: Slower nail growth, breakage, ridges, or discoloration may be experienced. Moisturize nails, keep them short, wear protective gloves.
• Stomach Pain: Pain, bloating, indigestion, or discomfort in the abdomen. Your doctor can prescribe medications to alleviate these symptoms.
• Effects on Kidneys and Liver: Blood tests monitor kidney and liver function. Maintain hydration and report any unusual symptoms
• Fatigue: This treatment may cause fatigue or weakness, which can impact daily activities.
• Sore Eyes and Sensitivity to the Sun: Watery eyes and discomfort may occur, treated with prescribed eye drops; inform your doctor if redness develops (conjunctivitis).
• Muscle or Joint Pain: Post-treatment pain in muscles or joints may arise; notify your doctor for pain relief, especially if persistent.
• Effects on the Nervous System: Report any unusual symptoms like weakness, numbness, or headaches to your doctor immediately.
Less Common Side Effects:
• Effects on the Lungs: Notify your doctor of any respiratory symptoms like coughing or breathlessness.
• Ear Problems: Rarely, ear pain, hearing loss, or ringing in the ears may be experienced.
• Cardiac and Organ Health: Regular cardiac monitoring and blood tests are imperative for patients on Doxorubicin due to potential cumulative effects.
• Renal Problems: You will be carefully hydrated throughout your treatment to avoid injuries to your kidney function.
• Numbness and tingling in hands and feet: This treatment can cause numbness, tingling, or pain in the hands or feet; inform your doctor for possible dose adjustments.
Precautionary Measures for Sarcoma Patients
• Blood clot risk: Report symptoms like swelling, breathlessness, or sharp chest pain immediately.
• Communication: Always prioritize informing your healthcare team about ongoing sarcoma treatments, ensuring coordinated care and potential adjustments.
• Vaccinations: Sarcoma patients should be aware of vaccination recommendations, especially considering treatment impacts on immune responses.
• Sex and Contraception: This treatment may impact fertility; discuss and plan contraception strategies with your oncologists.
• Breastfeeding: Avoid while having treatment.
Understanding the details of this treatment, including its administration, potential side effects, and precautionary measures, empowers patients to actively participate in their care and optimize treatment outcomes. Always communicate openly with your healthcare team for personalized guidance and support.