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BEACOPP

BEACOPP is the name of a combination of cancer drugs that includes: 

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

It is a treatment for Hodgkin lymphoma.

How it works

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

How you have BEACOPP

You have some chemotherapy drugs from BEACOPP into your bloodstream (intravenously). These include bleomycin, etoposide, doxorubicin, cyclophosphamide and vincristine.

You take procarbazine and prednisolone as capsules or tablets. 

Into your bloodstream

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

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your tablets or capsules

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have BEACOPP

You have BEACOPP chemotherapy as cycles of treatment. You might have BEACOPP over 2 weeks (14 days) or 3 weeks (21 days - this is also called escalated BEACOPP). You might have between 2 to 8 cycles. This is about 6 months in total for all 8 cycles.

Day 1
  • You have etoposide as a drip into your bloodstream (intravenously) over 60 minutes.
  • You have doxorubicin as an injection into your bloodstream.
  • You have cyclophosphamide as an injection into your bloodstream.
  • You take procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 2 and day 3
  • You have etoposide as a drip into your bloodstream over 60 minutes.
  • You take procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 4 to day 7
  • You take procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 8
  • You have bleomycin as a drip into your bloodstream.
  • You have vincristine as a drip into your bloodstream.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 9 to day 13
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
  • You have G-CSF as an injection (this helps the body produce white blood cells to reduce the risk of infection).
Day 14
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.

You then start your next treatment cycle.

You have a higher amount (dose) of chemotherapy drugs with this regimen.

Day 1
  • You have etoposide as a drip into your bloodstream (intravenously) over 60 minutes.
  • You have doxorubicin as an injection into your bloodstream.
  • You have cyclophosphamide as a drip into your bloodstream.
  • You take procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
  • You have mesna as a drip into your bloodstream. Mesna isn't chemotherapy. It helps to stop the cyclophosphamide from irritating your bladder and making it bleed.
Day 2 and 3
  • You have etoposide as a drip into your bloodstream over 60 minutes.
  • You take procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 4 to day 7
  • You have procarbazine as capsules - swallow it whole with plenty of water.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 8
  • You have bleomycin as a drip into your bloodstream.
  • You have vincristine as a drip into your bloodstream.
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
Day 9 to day 13
  • You take prednisolone as tablets - swallow it whole with plenty of water after breakfast.
  • You have G-CSF as an injection under your skin (this helps the body produce white blood cells to reduce the risk of infection).
Day 15 to day 21
  • You have no treatment.

You then start your next treatment cycle.

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.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely 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. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (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. 

Breathlessness and looking pale

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

Bruising, bleeding gums or nose bleeds

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).

Lung problems

You might develop a cough or breathing problems. This could be due to scarring (fibrosis) or infection, such as pneumonia or inflammation of the lungs. Let your doctor or nurse know straight away if you suddenly become short of breath or develop a cough. This can be life-threatening.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all 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 treating it once it has started.

High temperature and chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Contact your advice line straight away if you have signs of infection, including a temperature above 37.5C or below 36C.

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after having this treatment.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Heart problems

You may have changes to how your heart works. This can cause changes to your heart rhythm. Less commonly you might have a heart attack.

Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG) Open a glossary item.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Inflammation of the bladder

Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. 

Contact your advice line straight away if you see blood in your urine.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Changes to your finger tips

The tips of your finger might get tender, red, harden or swell. Let your doctor or nurse know if this gets sore.

Nail changes

Your nails might develop ridges or change colour. This gradually improves after treatment as your nails grow. Rarely your nails might detach from the skin. Let your doctor or nurse know if you think this is happening.

Skin changes

You might notice skin changes, such as a rash, itching, reddening, blistering, dryness, cracking, hardening or thickening of the skin. Areas of skin might change colour and you might also develop stretch marks.

Let your healthcare team know if you’re worried about an area of skin. They might be able to give you something to help.

Occasional side effects

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

  • an allergic reaction that can cause a rash, shortness of breath, cough, redness or swelling of the face
  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • blood clots what are life threatening; signs of 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
  • headache
  • a second cancer called acute leukaemia
  • dizziness
  • high blood pressure – symptoms include chest pain, difficulty breathing, irregular heartbeat, feeling weak and tired
  • inflammation around the drip site (extravasation) – signs include redness, swelling, leaking at your drip site. Rarely the tissue in the area might go hard
  • changes to your mood which can make you feel sad or depressed
  • difficulty thinking properly, easily confused and forgetful
  • having trouble sleeping
  • feeling anxious
  • hearing, feeling or seeing things

Rare side effects

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

  • tumour pain or pain in the area around the tumour
  • low blood pressure - you might feel sick, dizzy, lightheaded or even faint
  • pain in different parts of your body such as the muscles, bones and joints
  • problems passing urine - this might include not passing enough, going too often, wanting to go but you can’t or it being too difficult and painful
  • narrowing, thickening and hardening of the blood vessel walls
  • numbness, tingling or pins and needles in the fingers or toes
  • eye problems such as conjunctivitis – signs include inflammation, sore, sticky, watery, itchy or gritty eyes
  • passing blood from your bottom or in your stools (poo)
  • dry, flaky, red and sore skin in areas where you have had radiotherapy in the past
  • lack of fluid in the body (dehydration)
  • your nerves might be more sensitive which could cause pain, that might feel like burning, stinging or intense stabbing pain anywhere in the body
  • loss of hearing
  • flushing of the skin

Other side effects

There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • seizures (fits)
  • periods stopping
  • taste changes
  • eyesight problems such as unusual eye movements or your eyesight getting worse
  • 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

If you have side effects that aren’t listed on this page, you can look at the individual drug pages:

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.

Loss of fertility

You may not be able to become pregnant or father a child 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.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

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

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

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 the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

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.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. 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 go to the electronic Medicines Compendium (eMC) website.

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

Last reviewed: 
09 Jun 2020
Next review due: 
09 Jun 2023
  • Electronic Medicines Compendium 
    Accessed April 2020

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Guidelines for the first line management of classical Hodgkin lymphoma
    G A Follows and others
    British Journal of Haematology, 2014. Volume166, Issue 1, Pages 34 – 39

  • Hodgkin lymphoma: ESMO: Clinical Practice Guidelines for diagnosis, treatment and follow – up
    D A Eichenauer and others
    Annals of Oncology, 2018. Volume 29, Issue 4, Pages iv19 – iv29

  • Frontline Therapy for Classical Hodgkin Lymphoma by Stage and prognostic Factors
    P B Allen and L I Gordon
    Clinical Medicine Insights: Oncology, 2017. Volume 11, Pages 1 – 10

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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