A trial looking at treatment after surgery for people with osteosarcoma (Euramos 1 trial)

Cancer type:

Bone cancer
Children's cancers




Phase 3

This trial looked at treatment for people who had an operation to remove osteosarcoma. Cancer Research UK supported this trial.

More about this trial

Osteosarcoma is a type of bone cancer. Doctors often treat it with chemotherapy both before and after surgery. The chemotherapy drugs doctors usually use are;

This combination of drugs is often called MAP. MAP chemotherapy is given before and after surgery. This helps stop the osteosarcoma coming back.

Doctors thought that adding other treatments to MAP after surgery may work even better. But they were not sure how well the new combinations of treatment would work. All treatments have side effects, so it is important that people do not have treatments they don’t need.

After surgery, a doctor called a pathologist Open a glossary item looked at the tumour the surgeon took out. The pathologist could see how well MAP was working already. The pathologist split the group into people where MAP was working well and those in whom it was working less well. 

In the lower risk group, where MAP was working well, some people had MAP after surgery as normal. Some people had MAP plus interferon, called MAPifn. The interferon was given as an injection under the skin every week for up to 18 months.

In the high risk group, where MAP was working less well, some people had MAP after surgery as normal. Some people had MAP plus ifosfamide and etoposide, called MAPIE.

The aim of this trial was to compare these treatments to find out which one was the best treatment after surgery for each of these two groups of people with osteosarcoma.

Summary of results

The trial team didn’t find that having interferon after MAP helped the lower risk people with osteosarcoma.

They also found that adding ifosphamide and etoposide to MAP after surgery didn't help the high risk people.

This was a phase 3 trial. It recruited 2,260 people. It was a randomised trial.

Everyone had 2 cycles of MAP chemotherapy before their surgery. In the lab the pathologists then looked at some of the sarcoma they had removed to see how well the chemotherapy had worked.

The people whose cancer responded well were randomised to have either MAP or MAPifn. This was the low risk group.

Those whose cancer didn’t respond well were randomised into MAP or MAPIE. this was the high risk group. 

Low risk group

1,041 people were in the group whose cancer had responded well and 716 of them agreed to be randomised.

  • 359 had MAP
  • 357 had MAPifn

After an average follow up of 3 years, the researchers looked at how many people were free of osteosarcoma. Of these, they found that

  • 266 people who had MAP
  • 276 people who had MAP followed by interferon

The trial team concluded that at the moment having interferon after MAP chemotherapy doesn’t appear to better than having MAP only.

High risk group

1,060 people were in the high risk group. 618 were randomised.

  • 310 people had MAP
  • 318 people had MAPIE

After an average follow up of 5 years, the researchers looked at how many people were free of osteosarcoma. They found that this was

  • 157 people who had MAP
  • 154 people who had MAPIE

Although the side effects were similar they were more severe for the people who had MAPIE.

The trial team concluded they couldn’t support adding ifosphamide and etoposide to MAP after surgery. Because it didn’t work any better and the side effects were more severe.  

The trial team are continuing to follow up people who took part in the trial. When more results become available we will update the summary.

We have based this summary on information from the team who ran the trial. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) but may not have been published in a medical journal.  The figures we quote above were provided by the trial team. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Prof Jeremy Whelan

Supported by

Cancer Research UK
European Osteosarcoma Intergroup (EOI)
European Science Foundation (ESF)
Experimental Cancer Medicine Centre (ECMC)
German-Austrian-Swiss Cooperative Osteosarcoma Study Group (COSS)
Medical Research Council (MRC)
NIHR Clinical Research Network: Cancer
North American Children's Oncology Group (COG)
Scandinavian Sarcoma Group (SSG)

Other information

This is Cancer Research UK trial number CRUK/05/013.

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:


Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Cara took part in a clinical trial

A picture of Cara

"I am glad that taking part in a trial might help others on their own cancer journey.”

Last reviewed:

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