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Systemic Anti-Cancer Therapy Regimen Library

Home > LYM HL Classic Advanced - escBEACOPP [bleomycin, etoposide, DOXOrubicin, CYCLOPHOSPHamide, vinCRISTine, prEDNISone and procarbazine] interim PET-guided [under 60 years] > LYM - escBEACOPP Level 4 [starting level]
This regimen is a component of LYM HL Classic Advanced - escBEACOPP [bleomycin, etoposide, DOXOrubicin, CYCLOPHOSPHamide, vinCRISTine, prEDNISone and procarbazine] interim PET-guided [under 60 years]

Starting level - Level 4 (LYM HL Classic Advanced - escBEACOPP [bleomycin, etoposide, DOXOrubicin, CYCLOPHOSPHamide, vinCRISTine, prEDNISone and procarbazine] interim PET-guided [under 60 years])

Treatment Overview

Cycles 1 to 6 or de-escalate to appropriate level as per WCC, platelet counts and WHO grade 4 toxicities.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 6 - 21 days

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days

Medication Dose Route Days Max Duration
prEDNISone 40 mg/m² Once daily oral administration 1 to 14
procarbazine 100 mg/m² Once daily oral administration 1 to 7
DOXOrubicin 35 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide 1250 mg/m² intravenous 1 60 minutes
etoposide (as phosphate) * 200 mg/m² Once daily intravenous 1, 2, 3 60 minutes
pegFILGRASTIM 6 mg subcutaneous injection 4
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 8 10 minutes
bleomycin * 10000 international unit/m² intravenous 8 10 minutes

Full details

Cycles 1 to 6 - 21 days

Day: 1

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.
DOXOrubicin 35 mg/m² intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
CYCLOPHOSPHamide 1250 mg/m² intravenous 60 minutes
Instructions:

Consider hydration with at least 2000 to 3000 ml over 24 hours as oral or IV fluid on day(s) of CYCLOPHOSPHamide and for 24 hours after or as per institutional practice.
etoposide (as phosphate) * 200 mg/m² Once daily intravenous 60 minutes

Day: 2

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.
etoposide (as phosphate) * 200 mg/m² Once daily intravenous 60 minutes

Day: 3

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.
etoposide (as phosphate) * 200 mg/m² Once daily intravenous 60 minutes

Day: 4

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.
pegFILGRASTIM 6 mg subcutaneous injection
Instructions:

At least 24 hours after day 3 etoposide administration.

Day: 5

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.

Day: 6

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.

Day: 7

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
procarbazine 100 mg/m² Once daily oral administration
Instructions:
  • Take at night with food.
  • Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store.
  • Round dose to closest multiple of 50 mg capsules.

Day: 8

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.
vinCRISTine 1.4 mg/m² Cap dose per administration at: 2 mg intravenous 10 minutes
Instructions:
  • Diluted in a minibag.
  • FOR INTRAVENOUS USE ONLY – fatal if given by any other routes.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
bleomycin * 10000 international unit/m² intravenous 10 minutes
Instructions:

High risk of febrile infusion reaction.

Day: 9

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Day: 10

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Day: 11

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Day: 12

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Day: 13

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Day: 14

Medication Dose Route Max duration Details
prEDNISone 40 mg/m² Once daily oral administration
Instructions:

Take in the morning with food.

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis may be considered
Constipation risk: laxatives are usually prescribed
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Growth factor support: Recommended for primary prophylaxis
Hydration: Hydration may be considered
Irradiated blood components: Irradiation of blood components is recommended
Mesna uroprotection: Mesna uroprotection may be considered
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.


Emetogenicity: HIGH day 1; MEDIUM to HIGH (oral) days 2 to 7; MINIMAL day 8.


Irradiated blood components: Required for Hodgkin lymphoma patients at all stages of disease and therapy. Continue indefinitely.

References

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.