BEACOPP is the name of a chemotherapy regimen (drug schedule) used in the treatment of advanced-stage Hodgkin lymphoma. It is a common and effective chemotherapy regimen for newly diagnosed patients who have widespread disease. Though not commonly used in the U.S., it is considered the standard chemotherapy combination for stage III or IV Hodgkin lymphoma in some European countries.
Drugs Used in the BEACOPP Regimen
A combination of seven drugs is used in BEACOPP.
- Cytoxan/Neosar (Cyclophosphamide): Given as an infusion in your veins on day 1.
- Adriamycin/Rubex (Doxorubicin): Given as an infusion in your veins on day 1.
- VePesid (Etoposide): Given as an infusion in your veins on days 1 to 3.
- Matulane (Procarbazine): Given as pills to be taken by mouth on days 1 to 7.
- Prednisone: Given as pills to be taken by mouth on days 1 to 14.
- Blenoxane (Bleomycin): Given as a short intravenous injection on day 8.
- Oncovin (Vincristine): Given as a short intravenous infusion on day 8.
Each cycle of BEACOPP consists of administration of these 7 drugs on the scheduled days. Each cycle is repeated every 21 days.
Usually, six to eight cycles of BEACOPP are required as a full course of chemotherapy in advanced-stage disease.
Before BEACOPP chemotherapy is started, blood counts, as well as blood tests for kidney and liver function, are done. An echocardiogram (heart ultrasound) is required to test heart function before the treatment begins. As doxorubicin may occasionally affect the heart, it’s important to have that information for comparison later on during the treatment. A chest X-ray and lung function tests may be used to gauge the fitness of the lungs prior to the use of bleomycin, as this drug can affect the lungs (pulmonary toxicity).
During chemotherapy, blood counts are required before every drug injection cycle. Other tests may be repeated as required.
Since chemotherapy attacks rapidly dividing cells like cancer cells, it can also affect normal cells in your body that multiply frequently, such as those in your bone marrow, stomach lining, and hair follicles. This can cause:
- A low white blood cell count. A fall in your white count is very common and will be routinely monitored. Growth factor drugs such as Neulasta and Neupogen are used frequently along with chemotherapy drugs to raise your white blood cell count. If your white count remains low even with these growth factors, chemotherapy will likely be delayed until your levels have returned to acceptable levels. Since you have fewer immune cells to protect you against infection, it is very important to follow the protective measures your oncologist will tell you about. It’s also very important to call your healthcare provider immediately while on this chemotherapy regimen if you should develop a fever or any other signs of an infection.
- Nausea and vomiting may be common, and anti-emetics (drugs that prevent and control nausea and vomiting) will be routinely prescribed. Some medications are given to prevent nausea and vomiting, while others are prescribed to treat nausea which is already present. It’s very important to use preventive medications before you develop any nausea, as they are less effective after you already have symptoms. Your healthcare provider will talk to you about the different types of nausea, and how medications work for each of these.
- Hair loss is very common and frequently begins a few weeks after your first chemotherapy sessions. Preparing ahead—finding a wig or head covers—is helpful for some people. Your hair will grow back, so some people find it helpful to refocus and imagine the chemotherapy doing its job in watching their hair become thin and fall out.
- Mouth sores from chemotherapy are mostly a nuisance, but sometimes an infection can develop in the area of the sores. It can be helpful to avoid foods that are “sharp” such as toast and crackers and eat foods instead that are soft—such as scrambled eggs and mashed potatoes. Salty foods and those with citric acid can likewise cause discomfort. Learning what foods are better and worse to eat with mouth sores can go a long way in making this side effect more tolerable.
- Diarrhea can be serious when you are going through chemotherapy. Make sure to talk to your healthcare provider if you develop this symptom, and make sure to drink plenty of fluids to decrease the risk of dehydration.
- Fingernail and toenail changes are common with the chemotherapy drugs in this regimen.
- Peripheral neuropathy, or nerve changes which may result in some mild alteration of sensations in your hands and feet.
If you’ve recently been diagnosed, it can be overwhelming to know where to start. Reach out to family and friends. This is a good time to learn to let people help you. Consider joining a support group in your community, or connect with other people online via social media. And hang on to hope. Cancer treatments—as well as management of side effects—have improved greatly in recent years.