# EURAMOS-1

Source: https://onco.cc/trials/euramos-1/  
OnCo record `euramos-1` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The largest osteosarcoma trial ever run, across four cooperative groups on two continents. Neither adding interferon for good responders nor adding ifosfamide and etoposide for poor responders improved outcomes, so three-drug MAP chemotherapy remained the standard and the field turned to new biology.

## Summary

2,260 patients registered from 325 sites in 17 countries between 2005 and 2011. Poor responders (at least 10% viable tumour after MAP induction; 618 randomised) had identical event-free survival with MAPIE versus MAP (HR 0.98) and substantially more toxicity (Marina et al., Lancet Oncol 2016). Good responders (716 randomised) had no significant EFS gain from maintenance pegylated interferon alfa-2b, with 3-year EFS 76% overall and a large proportion never starting or stopping interferon early (Bielack et al., JCO 2015). EURAMOS-1 defined MAP (high-dose methotrexate, doxorubicin, cisplatin) as the international standard, showed that intensifying chemotherapy on the basis of histological response does not help, and demonstrated that four national groups could run one protocol. Its biobank underpins later genomic work on osteosarcoma.

## Fields

- Kind: Trial
- Status: negative
- Last checked: 2026-09-10
- Tags: nci-coverage; paediatric; bone; lesson:intensification-without-benefit
- Registry id: NCT00134030
- Phase: 3
- Setting: Resectable high-grade osteosarcoma, age up to 40: MAP induction, then randomisation by histological response (good responders: MAP vs MAP + pegylated interferon alfa-2b; poor responders: MAP vs MAPIE with ifosfamide and etoposide)
- Sponsor: Children's Oncology Group, COSS, EOI and SSG (EURAMOS collaboration)
- Enrolled: 2260
- Result: Poor responders: EFS HR 0.98 for MAPIE vs MAP, more toxicity. Good responders: no EFS benefit from interferon.
- Outcomes: Event-free survival, poor responders (MAPIE vs MAP): MAPIE vs MAP, HR 0.98; 3-year event-free survival, good responders (all randomised): MAP with or without interferon alfa-2b 76%
- Replication: Consistent with the earlier INT-0133 and COSS experience that adding agents to MAP does not improve survival; no subsequent trial has displaced MAP.

## Sources

- ClinicalTrials.gov NCT00134030: https://clinicaltrials.gov/study/NCT00134030
- Marina et al., Lancet Oncology 2016 (poor responders): https://doi.org/10.1016/S1470-2045(16)30214-5
- Bielack et al., JCO 2015 (good responders): https://doi.org/10.1200/JCO.2014.60.0734

## Connected records

- cancers: [Osteosarcoma](https://onco.cc/cancers/osteosarcoma/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Limb-salvage surgery and endoprosthetic reconstruction](https://onco.cc/technologies/limb-salvage-surgery/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Etoposide](https://onco.cc/drugs/etoposide/), [Ifosfamide](https://onco.cc/drugs/ifosfamide/), [Interferon alfa-2a/2b](https://onco.cc/drugs/interferon-alfa/), [Methotrexate](https://onco.cc/drugs/methotrexate/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [SIOP Europe (European Society for Paediatric Oncology)](https://onco.cc/institutions/siop-europe/)
- bottlenecks: [Failures are hidden](https://onco.cc/bottlenecks/b-negative-results/), [Rare and paediatric cancers without markets](https://onco.cc/bottlenecks/b-rare-cancers/)
- key papers: [Comparison of MAPIE versus MAP in patients with a poor response to preoperative chemotherapy for newly diagnosed high-grade osteosarcoma (EURAMOS-1): an open-label, international, randomised controlled trial](https://onco.cc/key-papers/paper-marina-lancet-oncol/), [Methotrexate, Doxorubicin, and Cisplatin (MAP) Plus Maintenance Pegylated Interferon Alfa-2b Versus MAP Alone in Patients With Resectable High-Grade Osteosarcoma and Good Histologic Response to Preoperative MAP: First Results of the EURAMOS-1 Good Response Randomized Controlled Trial](https://onco.cc/key-papers/paper-bielack-j-clin-oncol/)
- roadmaps: [Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first](https://onco.cc/roadmaps/paediatric-oncology-roadmap/)

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