BEACOPP

BEACOPP is the name of a combination of cancer drugs. It includes the chemotherapy drugs we list below. Next to each drug we have written how you pronounce the drug name in brackets.

• 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 (vin-kris-teen) also called Oncovin
• P – Procarbazine proh-kar-buh-zeen)
• P – Prednisolone (pred-nis-oh-lone)

BEACOPP is a treatment for Hodgkin lymphoma.

How does BEACOPP work?

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

Prednisolone is a steroid. Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system and reducing inflammation.

How do 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 as capsules. You swallow the capsules whole with a glass of water. You can take them with or without food.

You take prednisolone as a tablet. You should take your prednisolone tablets 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.

Taking your tablets or capsules

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 healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you have BEACOPP?

You have BEACOPP chemotherapy as cycles of treatment. You might have:

• BEACOPP over 2 weeks (14 days) also called BEACOPP -14 or
• BEACOPP over 3 weeks (21 days). This is also called escalated BEACOPP

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.

What are the side effects of BEACOPP?

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. 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, 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. 

Less commonly you might develop a life-threatening breathing problem. This is called acute respiratory distress syndrome (ARDS) or you might have lung failure. Rarely you might have a severe chest infection or scarring in the lung.

Let your healthcare team know straight away if you suddenly become breathless, have changes in your breathing, feel faint due to not being able to breathe properly, feel drowsy or confused or getting very tired.

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. This can cause changes to your heart rhythm. 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 or a heart attack. Rarely this can cause heart failure.

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 have a wee

Symptoms include pain when having a wee, and the need to wee more often or less often. Or you want to do a wee but you can’t. Occasionally you may see blood in your wee.

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 the skin on your hands and feet 

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. You might also have tenderness and swelling of the fingertips.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

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. Your skin may also be more sensitive to sunlight. Areas of skin might change colour.

Inflammation of the lining of the digestive system

You might have inflammation along your digestive system including your mouth throat and tummy.

Speak to your doctor or nurse if you have this.

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 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

• 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 the veins

• eye problems such as conjunctivitis – signs include inflammation, sore, sticky, watery, itchy or gritty eyes. Rarely it can affect your eyesight, for example, your eyesight may get worse or loss of vision. You might also have unusual eye movements

• low sperm count

• swelling (oedema)

• low levels of sodium in your blood – symptoms include feeling sick, dizzy and disorientated

Rare side effects

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

• pain in different parts of your body such as the muscles, bones and joints
• tumour pain or pain in the area around the tumour 
• thickening, inflammation and hardening of the blood vessel walls 
• dry, flaky, red, and sore skin in areas where you have had radiotherapy in the past
• inflammation of the lung if you’ve previously had radiotherapy to the chest
• 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- this might be permanent for some people. You may also have difficulty with balance including dizziness and feeling like the room is spinning 
• flushing of the skin
• muscle weakness
• seizures (fits)
• taste changes
• difficulty swallowing
• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• stroke
• confusion 
• an autoimmune condition called scleroderma – you might have areas of hardened skin or damage to other connective tissues
• changes to the 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
• high uric acid levels in your wee - due to the breakdown of cancer cells (you might have medicines to prevent this) 
• unexpected bleeding from your bowel, such as blood in your poo. Also inflammation and pain in the bowel 
• irregular or no periods

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

• developing symptoms such as a swollen or puffy face, acne, thicker more visible facial hair due to too much of a hormone called cortisol in your body

• 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
• Procarbazine 
• Prednisolone

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.

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

Don’t breastfeed during this treatment. 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, yellow fever and one of the shingles vaccines called Zostavax.

You can 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 it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet 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.