BEACOPDac

BEACOPDac is the name of a combination of cancer drugs. It includes the medicines we list below.

• B – bleomycin (blee-o-my-sin)
• E – etoposide (ee-top-o-side)
• A – doxorubicin (doks-oh-roo-bi-sin) also called Adriamycin
• C – cyclophosphamide (sigh-clo-fos-fah-mide)
• O – vincristine also called Oncovin
• P – prednisolone (pred-nis-oh-lone)
• Dac – dacarbazine (da-car-ba-zeen)

BEACOPDac is a treatment for Hodgkin lymphoma.

You can have BEACOPDac over 2 weeks, this is called BEACOPDac-14. Or over 3 weeks, this is called escalated BEACOPDac. 

This page is about escalated BEACOPDac.

How does BEACOPDac work?

All the medicines listed, except prednisolone are chemotherapy drugs. They work by destroying quickly dividing cells, such as cancer cells.

Prednisolone is a steroid. It treats the cancer by killing the cancer cells. It may also help you feel less sick during treatment. Steroids are naturally made by our bodies in small amounts.

How do you have BEACOPDac?

You have the chemotherapy drugs into your bloodstream through a drip into a vein. This is known as intravenous treatment. These include bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine and dacarbazine.

You take prednisolone as a tablet. You should take your prednisolone tablets just after a meal as they can irritate your stomach. 

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. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if they leak out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

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

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have BEACOPDac?

You have BEACOPDac chemotherapy as cycles of treatment . Each cycle of escalated BEACOPDac lasts 3 weeks (21 days). You have between 2 to 6 cycles of treatment.

This is one way of having a cycle of escalated BEACOPDac:

You then start your next treatment cycle.

G-CSF

You also have G-CSF. This is an injection under the skin. It is called a subcutaneous injection. It helps your body make white blood cells to lower your chance of getting an infection. You have this on day 4 to 7 and day 9 to 12. You continue or stop early when your blood counts recover.

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.

You might have heart tests such as an echocardiogram or ECG before your treatment.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of BEACOPDac?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

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

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 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, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling 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. This is known as petechiae.

Less often you may have uncontrolled bleeding from other areas of the body. Let your nurse or doctor know if you notice any bruising or are bleeding from anywhere.

Lung problems

You might develop breathing problems such as shortness of breath or a cough. This could be due to scarring (fibrosis), infection or inflammation of the lungs. 

Other lung problems include lung failure or acute respiratory distress syndrome (ARDS), but these are less common. ARDS is a life-threatening breathing problem.

Risk of blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Loss of appetite and weight loss

You might not feel like eating and may lose weight. 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. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

High temperature and chills

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

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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 healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Heart problems

You may have changes to how your heart works. Tests might pick up changes to your heart rhythm or how well it’s working. Less commonly it might affect how the heart pumps blood around the body. Symptoms include shortness of breath, ankle swelling, heart palpitations, feeling very tired and a cough. Or you might have chest pain, heart failure or a heart attack.

Your doctor may ask you to have tests to check your heart, such as an electrocardiogram (ECG) or an echocardiogram (ECHO).

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 and problems when you pee

Inflammation of the bladder (cystitis) can cause pain when peeing, you might need to go more often or less often. Or you might feel like you want to pee but you can’t.

You might have blood in your pee which you can see or is picked up on tests.

Contact your advice line if you have any of these symptoms.

Pain in different parts of the body

You might have pain in the tummy (abdomen), muscles and bones. Less commonly you might have pain in your jaw, mouth and throat. Rarely you might get pain at the site of the cancer.

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

Nail and fingertip changes

Your nails might separate from the nail bed, this usually isn’t painful. Your fingertips might be sore and swollen. Areas of your nail beds might be darker in colour, but this is less common.

Rarely your nails may get misshapen and change in colour.

Speak to your healthcare team to see if they can help.

Skin changes

You might notice skin changes such as a rash, itching, reddening, blistering, hardening or thickening of the skin. Your skin may be more sensitive to sunlight. And areas of skin might get lighter or darker in colour. You might have stretch marks, these usually start off darker but fade with time.

The skin on your hands and feet may become sore, red, or peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Less commonly this treatment can cause a raised itchy rash (urticaria). If you have had radiotherapy in the past, these areas might become red and sore. Some people develop a rash that has a particular pattern of straight lines. This can happen anytime from a few days to months after having the drug.

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Red or pink urine

You might have red or pink urine. This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 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. Some allergic reactions can be life threatening, alert your nurse or doctor if you notice any of these symptoms whilst having treatment or afterwards
• 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
• swelling to different parts of the body (oedema)
• headache
• a second cancer, for example, acute leukaemia
• dizziness
• high blood pressure - symptoms include chest pain, difficulty breathing, irregular heartbeat, feeling weak and tired
• low blood pressure - you might feel dizzy, sleepy, weak or lightheaded. You might also feel or be sick
• inflammation around the drip site (extravasation) - signs include redness, swelling, pain and leaking at your drip site. Tell your nurse straight away if you have any of these symptoms
• inflammation of the veins (phlebitis) causing pain, soreness or swelling of the affected area
• eye problems such as conjunctivitis - signs include inflammation, sore, sticky, watery, itchy or gritty eyes
• pain or burning feeling in your food pipe (oesophagus)
• you might have changes to your sperm or you may produce less sperm than normal
• slowing down or stopping of your gut movements, symptoms might include feeling bloated, stomach cramps, feeling or being sick

Rare side effects

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

• confusion 
• sores that are raised and inflamed at the corner of your mouth (angular cheilitis)
• thickening or hardening of the blood vessel walls 
• lack of fluid in the body (dehydration) 
• your nerves might be more sensitive which could cause pain, it might feel like burning, stinging or intense stabbing pain anywhere in your body
• loss of hearing - this might be permanent for some people
• flushing of the skin
• irregular or no periods
• you may go into a state similar to very deep sleep and not be able to respond – this is called a coma
• flu-like symptoms
• bowel problems, symptoms include abdominal pain or cramps, nausea, vomiting, diarrhoea. Blood, mucus or pus in your poo, changes to how often you want to poo

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:

• changes to your mood which can make you feel sad or depressed
• difficulty thinking properly, easily confused and forgetful
• difficulty sleeping
• feeling anxious
• hearing, feeling or seeing things that aren’t there
• a swollen or puffy face, acne, thicker more visible facial hair due to too much of a hormone called cortisol
• changes to blood sugar levels – you might have regular blood and urine tests to check this
• thinning of the bones, making them more brittle that increases the risk of them breaking (fracturing)
• indigestion or heartburn

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

• Bleomycin
• Etoposide
• Doxorubicin (Adriamycin)
• Cyclophosphamide
• Vincristine
• Prednisolone
• Dacarbazine

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Having blood after this treatment

After having this treatment you should only have blood or platelets that are first treated with radiation (irradiated). The radiation lowers the risk of a reaction between your blood cells and the cells in the transfusion. No harm comes from the irradiated blood.

In your medical records there is a note saying you should only have irradiated blood. You have a card to carry with this information. This is in case you need treatment at another hospital.

Loss of fertility

You may not be able to become pregnant or get someone pregnant 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 get someone pregnant while you are having treatment. Women must not become pregnant for at least a year after the end of treatment. Men should not get someone pregnant for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

Do not breastfeed during this treatment and for 1 month after your last dose. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

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