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regimen-monograph
BEACOPP
Intent
Curative
Regimen Category
Local
Funding Program
ODB - General Benefit
prednisone
Drugs Used
A - Regimen Name
BEACOPP Regimen
Bleomycin-Etoposide-ADRIAMYCIN ® (DOXOrubicin)-Cyclophosphamide-ONCOVIN ® (VinCRIStine)-Procarbazine-Prednisone
Disease Site
Hematologic - Lymphoma - Hodgkin's
Intent
Curative
Regimen Category
Local : A regimen not widely used by Regional Cancer Centres in this disease site.
Rationale and Uses
Treatment of unfavourable or advanced stage Hodgkin's lymphoma, in patients who are 15-65 years of age.
Supplementary Public Funding
procarbazine
ODB - General Benefit (with Therapeutic Notes) (procarbazine)
prednisone
ODB - General Benefit (prednisone)
B - Drug Regimen
| cyclophosphamide
(Round to nearest 10 mg) |
650 mg /m² | IV | Day 1 |
| DOXOrubicin
(Round to nearest 1 mg) |
25 mg /m² | IV | Day 1 |
| etoposide
(Round to nearest 10 mg) |
100 mg /m² | IV | Days 1 to 3 |
|
|
|||
| procarbazine | 100 mg /m² | PO | Daily, days 1 to 7 |
|
(Outpatient prescription in multiples of 50mg capsules)
|
|||
| prednisone | 40 mg /m² | PO | Daily, days 1 to 14 |
|
(Outpatient prescription in multiples of 5 mg and 50 mg tablets)
|
|||
| vinCRIStine
(Round to nearest 0.1 mg; maximum dose = 2 mg) |
1.4 mg /m² | IV | Day 8 |
| bleomycin
(Round to nearest 1 mg) |
10 mg /m² | IV | Day 8 |
D - Premedication and Supportive Measures
Antiemetic Regimen:
Moderate (Days 1 to 7)
Minimal (Day 8)
Other Supportive Care:
- Consider measures to preserve fertility or sperm/ovum banking.
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
On day 1 of cycle, platelets must be ≥ 100 x 109/L and ANC ≥ 1 x 109/L and toxicities recovered to ≤ grade 2. G-CSF support should be considered after first episode of febrile neutropenia or dose delay ≥ 1 week.
Cyclophosphamide, Etoposide, Doxorubicin, Procarbazine (% previous dose) |
|
Treatment delay of ≥ 2 weeks |
Hold until recovery then 75% |
|
Cardiotoxicity*
|
Discontinue doxorubicin |
|
Grade 3 related organ/ non-hematologic/
|
Hold until recovery, then 75% related drug(s)
|
|
Grade 4 related organ/ non-hematologic
|
Discontinue
|
Neurotoxicity:
|
Symptom
|
% usual dose of Vincristine
|
|
areflexia only
|
100 %
|
|
abnormal buttoning, writing
|
67 %
|
|
moderate motor neuropathy (± cranial)
|
Hold until recovery then reduce dose by 50%
|
|
severe motor neuropathy
|
Omit
|
Hepatic Impairment
|
AST/ALT
|
Bilirubin
|
Bleomycin
|
Etoposide
|
Doxorubicin
|
Cyclophosphamide
|
Vincristine
|
Procarbazine
|
| (% previous dose) | |||||||
|
|
1-2 x ULN
|
No change
|
50%
|
50%
|
No change
|
50%
|
75%
|
|
5-10 x ULN
|
> 2 - 4 x ULN
|
No change
|
25%
|
25%
|
Caution
|
25%
|
OMIT
|
> 10 x ULN |
> 4 x ULN
|
No change
|
OMIT
|
OMIT
|
Caution
|
OMIT
|
OMIT
|
Renal Impairment
|
Creatinine Clearance (mL/min)
|
Bleomycin
|
Etoposide
|
Doxorubicin
|
Cyclophosphamide
|
Vincristine
|
Procarbazine
|
| (% previous dose) | ||||||
|
>30-50
|
75%
|
No change |
No change |
50-75%
|
No change |
Consider dose reduction |
|
10-30
|
75%
|
No change |
No change |
50% or OMIT |
No change |
Consider dose reduction |
|
<10
|
50%
|
50% or OMIT |
No change |
OMIT
|
No change |
Consider dose reduction or OMIT |
F - Adverse Effects
Refer to cyclophosphamide, DOXOrubicin, etoposide, procarbazine, prednisone, vinCRIStine, bleomycin drug monograph(s) for additional details of adverse effects
(Continued on next page)
Most Common Side Effects |
Less Common Side Effects, but may be Severe |
·
|
|
G - Interactions
Refer to cyclophosphamide, DOXOrubicin, etoposide, procarbazine, prednisone, vinCRIStine, bleomycin drug monograph(s) for additional details
H - Drug Administration and Special Precautions
Refer to cyclophosphamide, DOXOrubicin, etoposide, procarbazine, prednisone, vinCRIStine, bleomycin drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Clinical toxicity assessment (including local toxicity, urogenital, GI, neurotoxicity, bleeding tendency, cardiotoxicity and pulmonary).
- CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary.
- Routine blood glucose test.
- Regular chest x-ray and routine pulmonary function test
- Baseline and regular liver and renal function tests (including electrolytes and magnesium), and urinalysis.
- Cardiac examination especially with risk factors (including prior therapy with Epirubicin, Mitoxantrone, and other cardiotoxic drugs), or a cumulative doxorubicin dose of > 450mg/m2.
- Baseline blood pressure at each treatment; monitor for hypotension.
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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J - Administrative Information
Prednisone, Procarbazine, Filgrastim: Outpatient prescription for home administration
Approximate Patient Visit
Day 1: 2 hours; Days 2, 3: 1 hour; Day 8: 0.5 hour
Pharmacy Workload (average time per visit)
22.114 minutes
Nursing Workload (average time per visit)
43.729 minutes
K - References
Diehl V, Sieber M, Ruffer U et al. BEACOPP : An intensified chemotherapy regimen in advanced Hodgkin's disease. Annals of Oncology 1997; 8: 143-148.
Diehl V, Franklin J, Hasenclever D, et al. BEACOPP, a New Dose-Escalated and Accelerated Regimen, Is at Least as Effective as COPP/ABVD in Patients With Advanced-Stage Hodgkin's Lymphoma: Interim Report From a Trial of the German Hodgkin's Lymphoma Study Group. J Clin Oncol 1998;16:3810-3821.
Diehl V, Franklin J, Hasenclever D et al. BEACOPP: A new regimen for advanced Hodgkin's disease. Annals of Oncology 1998; 9(Suppl. 5) : S67-71.
Diehl V, Franklin J, Pfreundschuh M, et al.Standard and Increased-Dose BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin’s Disease. N Engl J Med 2003;348:2386-95.
October 2017 Formatted public funding info; revised Jan 2012
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
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Last Updated: July 27, 2026
