What is BEACOPP?

BEACOPP is used to treat Hodgkin lymphoma. It is best to read this information with our general information about chemotherapy and Hodgkin lymphoma

BEACOPP is named after the initials of the drugs used:

BEACOPP is also known as BEACOPP-14.

Escalated BEACOPP uses the same drugs, but in different doses.

High doses of cyclophosphamide can sometimes irritate the lining of your bladder. A drug called mesna helps to protect your bladder from the irritation. It is usually given with escalated BEACOPP, and sometimes with BEACOPP.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

How BEACOPP is given

You will be given some of the drugs into a vein (intravenously) during a short stay in hospital. Or you may have them as an outpatient in the chemotherapy day unit. A chemotherapy nurse will give them to you. Some of the drugs come in tablets or capsules that you can take at home.

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 day 1 and day 8 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 talk to you about your blood results and 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. You will have the chemotherapy drugs into a vein through one of the following: 

  • a (cannula) – a short, thin tube the nurse puts into a vein in your arm or hand
  • a (central line) – a fine tube that goes under the skin of your chest and into a vein close by
  • a (PICC line) – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
  • an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.

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.

Your course of chemotherapy

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). Each cycle of escalated BEACOPP takes 3 weeks.  A cycle includes the days you have the BEACOPP drugs followed by a rest period. 

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 your treatment plan to take home.

  • On day 1 the nurse will give you doxorubicin, cyclophosphamide and etoposide. You may also have mesna, if needed. You will also start taking procarbazine and prednisolone. 
  • On days 2 and 3 the nurse will give you etoposide.
  • On day 8 the nurse will give you bleomycin and vincristine.

You take procarbazine for 7 days. You take prednisolone for either 7 or 14 days depending on whether you are having BEACOPP or escalated BEACOPP. Your nurse or pharmacist will explain when to take the tablets.

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 start the next 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.

Taking your capsules and tablets

Procarbazine 

Your doctor, nurse or pharmacist may advise you to avoid some types of foods and alcohol while taking procarbazine. These include:

  • mature cheese
  • salami
  • Oxo®, Bovril®, Marmite® and other beef or yeast extracts
  • alcohol
  • non-alcoholic beers and wines.

This is because they can react with procarbazine and cause side effects including:

  • feeling sick 
  • headaches 
  • sweating or flushing
  • drowsiness
  • breathing problems. 

This type of reaction is not common. But if you notice any of these symptoms, contact the hospital for advice. 

Procarbazine capsules must be swallowed whole with a glass of water. Do not chew, open or crush them. Take them at the same time every day on the days you have been told to.

If you forget to take the capsules, contact your doctor or nurse for advice. Do not take a double dose.

Other things to remember about your capsules:

  • Wash your hands after taking your 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.
  • 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.

Prednisolone

The prednisolone tablets should be taken after breakfast. This helps to reduce any risk of indigestion or stomach problems. It is best to take prednisolone in the morning rather than as separate doses through the day. If you take it later in the day, it may keep you awake at night.

About side effects

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.

More information

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) for more detailed information.

Side effects while treatment is being given

Some people may have side effects while they are being given the chemotherapy into a vein or shortly after they have it.

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed
  • shivering
  • itching
  • 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

The drug may leak outside the vein. If this happens 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.

Common side effects

Risk of infection

This treatment can reduce 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 may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines. 

You will have a drug called G-CSF on days 9 to 13 of each cycle of your treatment. This encourages the body to make more white blood cells. You have it as a small injection under the skin.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:

  • your temperature goes over 37.5°C (99.5F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection
  • your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) a lot, or discomfort when you pass urine.

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, until your cell count increases.

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:

  • nosebleeds
  • 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 sick

Your doctor will give you anti-sickness drugs to help prevent or control sickness during and after chemotherapy. 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 often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.

Changes in appetite

This treatment  can affect your appetite. You may feel like you don’t want to eat much. Or, while you are taking prednisolone, you may feel hungry and eat more than usual. 

Do not worry if your appetite changes for few days. But tell your doctor or nurse if:

  • you have indigestion – you may need medicines to help control this while you are taking prednisolone
  • your appetite does not come back after a few days – they may give you food or drink supplements or suggest changes to your diet or eating habits to help.

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.

Constipation

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.

Diarrhoea

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.

Bladder irritation

Cyclophosphamide may irritate your bladder and cause discomfort when you pee (pass urine). Drink at least 2 litres (3½ pints) of liquid in the 24-hour period after having the cyclophosphamide. It is also important to empty your bladder (pee) regularly, and to try to pass urine as soon as you feel the need to.

You will be given fluids through a drip, and may be given a drug called mesna to help prevent bladder irritation. You have mesna as a drip or tablets. 

Tell your nurse or doctor straight away if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.

Red or pink urine

After doxorubicin, your urine may be pink or red for up to 48 hours. This is because of the colour of the drug and is not harmful. But always check with your nurse if you have any concerns.

Hair loss

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 finishes.

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.

Jaw pain

Vincristine may cause pain in your jaw. If you notice this, tell your nurse or doctor.

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.

Skin changes

This treatment may affect your skin. It can cause a rash, which may be itchy. Patches of your skin may get darker during treatment. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

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 go away when treatment finishes.

Nail changes

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.

Sore eyes

Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed, tell your doctor. This is because you may need antibiotic eye drops to treat conjunctivitis.

Tumour lysis syndrome (TLS)

This treatment may cause cancer cells to die and break down quickly. When cancer cells break down very quickly, it can cause a sudden release of large amounts of chemicals into the blood. This is called tumour lysis syndrome (TLS).

Your kidneys can usually keep these chemicals balanced. But they might not be able to cope with very large amounts. The chemical imbalance can affect how well your kidneys work and cause problems with your heart rhythm.

You will have regular blood tests to check the levels of these chemicals.

If you are at risk of TLS, your doctor can give you treatment to help prevent it. You may have:

  • extra fluids through a drip
  • medicines such as rasburicase or allopurinol.

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

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
  • breathlessness
  • dizziness
  • 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.

Effects on the kidneys and liver

This treatment may affect how your kidneys or liver work. This is usually mild. You will have blood tests to check how well your kidneys and liver are working.

High blood pressure

This treatment can sometimes cause high blood pressure. Your nurse will check your blood pressure.

Raised blood sugar levels

Prednisolone can increase the level of sugar in your blood. Symptoms of raised blood sugar include:

  • feeling thirsty
  • needing to pass urine more often
  • feeling tired.

Tell your doctor or nurse if you have these symptoms.

If you have diabetes, you may need to monitor your blood sugar more closely while taking this drug.

Less common side effects

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
  • wheezing
  • breathlessness

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

This treatment can affect the nervous system. You may feel dizzy or unsteady. If you notice any of these symptoms, tell your doctor or nurse straight away. They may make some changes to your treatment if the symptoms become a problem for you. If you notice these effects, it is important not to drive or use machinery. Rarely, this treatment can cause fits (seizures).

Second cancer

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.

Other information

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.

Other medicines

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.

Grapefruit

During treatment with cyclophosphamide you should avoid grapefruit and grapefruit juice. It can affect how well cyclophosphamide works and may make the side effects worse.

Vaccinations

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.

Contraception

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.

Breastfeeding

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.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Changes to periods

If you have a period, these may become irregular or stop while you are having this treatment. This may be temporary, but it can sometimes be permanent. Your menopause may start sooner than it would have done. Your doctor or nurse can give you more information.

Sex

If you have sex during a course of this treatment, you should use barrier protection such as a condom or dental dam. This will protect your partner if any of the drug is in your semen or vaginal fluid.

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.

About our information


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.