Regimen BEACOPP – escalated

Indication Hodgkins lymphoma when inadequate response to ABVD after 2 cycles

Therapeutic Intent Radical/Curative

Day Medication Dose Route Administration Details

Slow bolus injection over 2-3 minutes into the
1 Doxorubicin 35mg/m2 IV side-arm of a fast running sodium chloride
0.9% infusion.
1 Cyclophosphamide 1250mg/m2 IV In 500ml sodium chloride 0.9% over 1 hour.
In 500-1000ml sodium chloride 0.9% over
1 to 3 Etoposide 200mg/m2 IV
minimum of 1 hour.
Round dose to nearest 50mg.The daily dose
1 to 7 Procarbazine 100mg/m2 PO
may be split evenly during the day.
1 to 14 Prednisolone 40mg/m2 PO Give as a single dose in the morning.
Give in 100-250ml sodium chloride 0.9% over
8 Bleomycin 10,000units/m2 IV
30 minutes.
Maximum dose 2mg. Made in a 50ml sodium
8 Vincristine 1.4mg/m2 IV chloride 0.9% minibag. Given over 5-10
minutes.

9-13 Daily G-CSF SC As per local policy.

Cycle Frequency Every 21 days for up to 4 cycles

Tests required prior to FBC, U&E, LFT, Bone profile, glucose, LDH, ECG +/- echocardiogram,
initiation of course Pulmonary function test.

Tests required prior to FBC, U&E, LFT.

individual cycle
Concurrent Medication
Ensure necessary radiological investigations are undertaken after cycle 3.
Allopurinol for at least the first cycle.
Anti-emetics as per local policy.
PPI.
PCP prophylaxis recommended.
Consider antifungal, antiviral, and mouthwashes as per local policy.

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Dose Modifications
Hepatic Serum Bilirubin (micromol/L) Modification
1.7 to 2.5 x upper limit of normal 50% dose of doxorubicin
2.5 to 4 x upper limit of normal 25% dose of doxorubicin
Greater than 4 x upper limit Contact Consultant for advice
26 to 51 50% doses of etoposide and vincristine
> 51 Clinical decision regarding further dose reduction
of etoposide.
50% dose vincristine if AST/ALT normal but if
AST/ALT >180 consider omission.
50% dose of procarbazine
Serum AST/ALT (Micromol/L) Dose Modification
60 to 180 50% dose etoposide and vincristine
>180 Clinical decision regarding further dose reduction
of etoposide
Consider omitting vincristine
Renal Creatinine clearance (ml/min) Modification
10 to 50 75% dose of cyclophosphamide and bleomycin
<10 50% dose of cyclophosphamide and bleomycin
30 to 60 85% dose of etoposide
<30 75% dose of etoposide
Serum creatinine (micromol/L) Modification
>177 50% dose of procarbazine
Haematological Cycles should be repeated on day 22 provided the white cell count > 2.5x109/L and the
platelet count > 80x109/L

The day 8 drugs should be given on schedule and at full dose regardless of blood counts.

Doses should be reduced in subsequent cycles if predefined toxic effects — CTCAEv3.0

grade 4 leucopenia (<1.0 x 109 /L) for more than four days; CTCAE grade 4
thrombocytopenia (<25 x 109 /L), infection, or mucositis; or an adverse effect that
requires a two-week delay in treatment — occur in a given cycle. After each such event,
the doses of cyclophosphamide and etoposide should be reduced by one level on a five-
level scale from escalated to standard doses as shown below. If toxic effects occur in two
successive cycles, standard doses should be used for all subsequent cycles.

Level 1 – escalated Level 2 Level 3 Level 4 Level 5

dose
Cyclophosphamide
1100mg/m2 950mg/m2 800mg/m2 650mg/m2
1250mg/m2
Etoposide
175mg/m2 150mg/m2 125mg/m2 100mg/m2
200mg/m2
Neurotoxicity If the patient complains of significant constipation or sensory loss in fingers and/or toes,
consider possible dose reduction of vincristine. For patients who develop ≥ grade 3 ileus,
treatment should be delayed until recovery and vincristine introduced at 75% of the
normal dose thereafter. If ≥ grade 3 ileus recurs, vincristine should be discontinued.

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Pulmonary All patients complaining of shortness of breath should have a CXR and pulmonary
Toxicity function tests prior to further administration of bleomycin. Bleomycin should be
discontinued if any clinical signs or CXR examination evidence of pulmonary infiltration.
Fibrosis develop or if the transfer factor is <50% of the predicted value.

Patients with Hodgkin’s Disease must receive irradiated cellular blood

components.
Additional Information
Dietary restrictions must be undertaken noted when taking procarbazine –
avoid alcohol (disulfiram reaction); avoid tyramine rich foods (weak MAOI
reaction).

References Adapted from NRCI RATHL trial protocol version 5.0

Author Pharmacy CNG

Approved & Checked by Haematology CNG (Review Date = Jan 2017)

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