BEACOPP chemotherapy regimen

BEACOPP is an acronym that represents a commonly used combination chemotherapy regimen in cancer treatment. BEACOPP consists of the following drugs:

• Bleomycin
• Etoposide
• Adriamycin (doxorubicin)
• Cyclophosphamide
• Oncovin (vincristine)
• Procarbazine
• Prednisone

BEACOPP may also be administered in higher doses; when this is the case, it is known as Dose-Escalated BEACOPP.

What BEACOPP is used for

BEACOPP was established by the German Hodgkins Study Group (GHSG) in 1998 in what was is known as the HD9 Trial¹, ² for the treatment of certain patients with Hodgkins lymphoma by raising the dose of drugs in the regimen and intensifying the cycles. Those 'certain patients' tend to have advanced disease, in the later stages (III or IV) and unfavorable (i.e. with B symptoms). The National Comprehensive Cancer Network includes BEACOPP in its standard treatment guidelines, reserving it for select patients with highly unfavorable, high-risk disease³.

Typically, BEACOPP is administered in dose escalated form every 21 days for 8 cycles, with a full restaging after 4 cycles (a more intense version consists of 14 day cycles). If the patient shows a complete response (CR), meaning there is no existing evidence of disease, the following four cycles would be baseline BEACOPP. If the response is partial (PR), the dose-escalated form is recommended³.

In 2009, the GHSG published a ten-year follow-up assessment of HD9 that demonstrated "a stabilized significant improvement" in long-term freedom from treatment failure (FFTF) and overall survival (OS) in patients with advanced-stage HL, suggesting that it may be a better option for this patient population than the more common ABVD regimen⁴.

BEACOPP Side effects: Overview

BEACOPP's most common side effects include an increased risk of infection due to a reduced white-cell count; anemia due to reduced red cell count (a blood transfusion may be necessary); and reduced platelet count, leaving the patient prone to bleeding. Fatigue, hair loss, sunlight sensitivity, and watery eyes, are other common side effects, along with a potential threat to the patient's fertility⁵.

References

• Diehl V et al. "BEACOPP: a new regimen for advanced Hodgkin's disease." Ann Oncol 1998;9 Suppl 5:S67-71
• Diehl V 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 16(12): 3810–21.
• NCCN Clinical Practice Guidelines in Oncology: Hodgkins lymphoma, V.2.2010
• Engert A et al. "Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study." J Clin Oncol. 2009 Sep 20;27(27):4548-54.
• Cancer Research UK: Common side effects of BEACOPP.