BEACOPP

BEACOPP is the name of a combination of chemotherapy drugs used to treat Hodgkin’s lymphoma. It is made up of the drugs

• B = Bleomycin
• E = Etoposide
• A = Doxorubicin (also called Adriamycin)
• C = Cyclophosphamide
• O = Vincristine (also called Oncovin)
• P = Procarbazine
• P = Prednisone (a steroid)

The links above take you to more information about the individual side effects of each of these drugs.

You usually have chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. You may have up to 8 cycles, taking about 6 months.

You take procarbazine and prednisone as tablets.

You have all the other drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula), put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You have each cycle of treatment in the following way.

• On the first day you have cyclophosphamide and doxorubicin as injections into your cannula or central line. You have etoposide as a drip. You also start taking procarbazine tablets for a week and prednisone tablets (steroids) for 2 weeks
• You have etoposide as a drip (infusion) on the following 2 days
• You have vincristine and bleomycin by drip one week after the day you started the treatment cycle

When you stop taking the prednisolone tablets you have a week with no treatment. You then start a new treatment cycle.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with BEACOPP are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being very sick affects up to 2 out of 10 people (20%), but is usually well controlled with anti sickness drugs
• Hair loss occurs in up to 8 out of 10 people (80%) but will grow back once the treatment ends
• Women may stop having periods (amenorrhoea) but this may be temporary
• Sensitivity to sunlight – don’t sit out in the sun, and cover up or use sun block on exposed skin
• Brown skin markings may occur along the line of the vein where the chemotherapy was injected
• Brittle, chipped and ridged nails may occur but this will grow out once the treatment has ended
• Gritty eyes, blurred vision or watery eyes may occur
• These drugs may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how these drugs affect fertility so do talk with your doctor before starting treatment if having a baby is important to you

Between 1 and 10 in every 100 people have one or more of these.

• A sore mouth affects up to 8 out of 100 people (8%) and may be severe
• Numbness or tingling in fingers and toes affects about 1 in 20 people (5%) and can cause difficulty with small tasks such as doing up buttons – it may start a few days or weeks after the beginning of treatment and usually gradually goes within a few months of treatment ending
• Inflammation of the lungs – let your doctor know if you have a dry cough, breathlessness, chest pain or a high temperature
• Damage to heart muscle – this is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment

In a very few people a second cancer may occur some years after the end of treatment.

You won't get all of the above effects. Some of those that occur may be mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the different drugs you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. You should have a contact number for your nurse. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.