BEACOPP is named after the initials of the drugs used:
- B – bleomycin
- E – etoposide
- A – doxorubicin (also called Adriamycin®)
- C – cyclophosphamide
- O – vincristine (also called Oncovin®)
- P – procarbazine
- P – prednisolone, a steroid.
Escalated BEACOPP is a similar regime which uses the same drugs, but in different doses.
A drug called mesna is usually given with escalated BEACOPP, and may be given with BEACOPP. Mesna helps to protect your bladder from irritation that could be caused by high doses of cyclophosphamide.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will usually be given BEACOPP during a short hospital stay. You have some of the chemotherapy as an outpatient. A chemotherapy nurse will give it to you.
During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:
- a short, thin tube the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line)
- as tablets or capsules that you take by mouth (orally)
Doxorubicin is given as a slow injection into your line or cannula. It may be given along with a drip (infusion) of fluids to flush it through.
Cyclophosphamide is given as a slow injection or as a drip over 30 minutes to an hour.
Etoposide, bleomycin and vincristine are all given as drips:
- etoposide is usually given over 60 minutes
- bleomycin is usually given over 30 minutes to an hour
- vincristine is usually given over 5 to 10 minutes, or longer.
Procarbazine and prednisolone are given as capsules and tablets that you swallow.
Procarbazine capsules must be swallowed whole with a glass of water. They should not be chewed, opened or crushed. Take them at the same time every day. Always take them as they have been explained. Your doctor, nurse of pharmacist may advise you to avoid certain types of foods and alcohol while taking procarbazine.
If you forget to take the capsules, you should take the missed dose as soon as possible unless your next dose is due within a couple of hours. In this case, you should skip the missed dose and continue with you regular schedule. Do not take a double dose.
Other things to remember about your capsules:
- Wash your hands after taking your tablets and capsules.
- Other people should avoid direct contact with the chemotherapy drugs.
- Keep them in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of sight and reach of children.
- Wash your hands straight after taking the capsules.
- If you are sick just after taking the capsules, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused capsules to the pharmacist.
The prednisolone tablets should be taken after breakfast. This helps to reduce any risk of indigestion or stomach problems. Prednisolone may also keep you awake at night if you take it later in the day, so it is best to take it in the morning.
You usually have a course of several cycles of treatment over a few months. Each cycle of BEACOPP usually takes 14 or 21 days (2 or 3 weeks). Escalated BEACOPP is given over 3 weeks.
You may have between 2 and 8 cycles of BEACOPP. Your nurse or doctor will discuss your treatment plan with you. They may give you a copy of a treatment plan to take home with you.
On day 1 the nurse will give you doxorubicin, cyclophosphamide and etoposide. You may also have mesna if needed, depending on your regime. You will also start taking procarbazine and prednisolone. The procarbazine is taken for 7 days. You take prednisolone for either 7 or14 days depending on whether you are having BEACOPP or escalated BEACOPP. Your nurse or pharmacist will explain when to take the tablets.
On days 2 and 3 the nurse will give you another drip of etoposide.
On day 8 the nurse will give you bleomycin and vincristine.
After you finish all your prednisolone tablets you have a rest period. This means you do not take any tablets for the next 7 days. After the rest period has finished you will start your second cycle of BEACOPP. This is the same as the first cycle.
Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Always take your medicines exactly as explained. This is to make sure they work as well as possible for you.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.
The drug leaks outside the vein
If the drug leaks outside the vein, it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the contact telephone number they gave you.
Pain along the vein
Risk of infection
This treatment reduces the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
Your doctor will give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.
If you have an infection, it is important to treat it as soon as possible. If you are having treatment as an outpatient contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.
Your doctor may give you G-CSF:
- if the number of white blood cells is very low
- to stop the number of white blood cells getting low.
You have it as a small injection under the skin.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.
If you feel sleepy, do not drive or use machinery.
You may feel sick during chemotherapy. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Loss of appetite
This treatment can affect your appetite. Do not worry if you don’t eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Sometimes prednisolone can make you feel more hungry than usual, so do not worry if you find you are eating more while taking it. Prednisolone can also sometimes increase the level of sugar in your blood. If you have diabetes you may need to monitor your blood sugar more closely while taking this drug.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
Problems passing urine (peeing)
This treatment may irritate your bladder and cause discomfort when you pass urine. Make sure you drink plenty of fluids. Try to drink at least 2 litres (3½ pints) of fluids a day.
Contact the hospital straight away if you:
- you are passing urine (peeing) more than usual
- you are peeing less than usual
- you feel any discomfort or stinging when you pass urine
- notice any blood in your urine.
Your hair will get thinner. Or you may lose all the hair from your head. You may also lose your eyelashes and eyebrows, as well as other body hair. Hair loss usually starts after your first or second treatment.
Your nurse can talk to you about ways to cope with [hair loss]. There are ways to cover up hair loss if you want to. Your scalp may be sensitive. It is important to cover your head to protect your skin when you are out in the sun.
Hair loss is almost always temporary. Your hair will usually grow back after treatment ends.
Muscle or joint pain
You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Vincristine may cause pain in your jaw. Tell your nurse or doctor if you notice this.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.
BEACOPP may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. BEACOPP can cause a rash, which may be itchy. Your skin may darken sometimes in patches during treatment.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. Sometimes nails can become loose or fall out. When treatment finishes, any changes usually disappear as the nails grow out.There are things you can do to look after your nails:
- Moisturise your nails and cuticles regularly.
- Keep your nails clipped short.
- Wear gloves to protect your nails when you are doing things in the house or garden.
- Keep your hands and nails clean to help avoid infection, but avoid bathing in very hot water.
- Do not use false nails, gels or other acrylics during this treatment, as they may increase the risk of infection.
- It is fine to wear nail varnish, but try to use a water-based polish. Avoid using harsh chemicals, such as acetone, when taking off the polish.
- If your toenails are affected, wear well-fitted shoes to cushion them.
Tell your doctor or nurse if you notice changes to your nails. They can give you advice or arrange for you to see a podiatrist for foot care advice if needed.
Your eyes may become watery and feel sore. Your doctor can give you eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. You may need antibiotic eye drops.
Raised levels of uric acid (tumour lysis syndrome)
This treatment may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you allopurinol tablets to help prevent this. Drinking at least 2 litres (3½ pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.
Sometimes levels of different salts in the body can be changed and you may need to have a fluid drip to replace these. You will have regular blood tests to check your levels.
Effects on the heart
This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.
Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Changes in the way the liver works
This treatment may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
High blood pressure
This treatment can cause high blood pressure. Your nurse will check your blood pressure regularly during your treatment.
Effects on the lungs
This treatment can cause changes to the lungs. You may have tests to check your lungs before and during treatment. It is very important to tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse.
Smoking can increase the risk of your lungs being affected. If you smoke, talk to your doctor about stopping before you start treatment.
After treatment with bleomycin, breathing in high doses of oxygen for several hours can cause lung problems. If you need to have a general anaesthetic or oxygen therapy in the future, always tell the doctor that you have had bleomycin. Some people choose to wear a medical alert identifier.
You should not scuba dive for a year after treatment with bleomycin. After this, you will need to have tests to check whether scuba diving is safe for you. Your cancer doctor can give you more information about this.
Effects on the nervous system
Procarbazine can affect the nervous system. You may have pins and needles or tingling in your arms and legs. You may also:
- feel dizzy or unsteady
- feel drowsy or confused
- have trouble sleeping.
Rarely, procarbazine can cause seizures (fits). Your doctor can prescribe drugs to stop fits. They will explain more about this.
If you notice any of these symptoms, tell your doctor or nurse straight away. They may alter your treatment if they become a problem for you. It is important not to drive or operate machinery if you notice these symptoms.
Interaction with alcohol and some foods
When taking procarbazine, you should avoid the following types of food and drink:
- mature cheese
- Oxo®, Bovril®, Marmite® and other beef or yeast extracts
- non-alcoholic beers and wines.
This is because they can cause a reaction. Signs of a reaction include:
- feeling sick
- sweating or flushing
- breathing problems.
This type of reaction is not common. But if you notice any of these symptoms, contact the hospital for advice. Your nurse, doctor or pharmacist can give you more advice on types of food and drink to avoid.
BEACOPP can increase the risk of developing a second cancer or a blood disorder called myelodysplastic syndrome years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.
If you have sex during a course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.