Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma

Abstract

Background/Objectives: Oral maintenance chemotherapy can effectively prolong overall survival (OS) in many types of metastatic cancer, but its role in metastatic nasopharyngeal carcinoma (mNPC) is unclear. In this study, the efficacy of oral maintenance chemotherapy in mNPC and the effectiveness of circulating tumor EBV-DNA for screening patients were evaluated. Methods: Between June 2016 and December 2017, 141 patients with mNPC who received platinum-based systemic chemotherapy were included (median follow-up time, 21 months). Patients were classified into two groups according to the administration of oral maintenance chemotherapy. Plasma samples were collected before, during, and after treatment for the measurement of circulating EBV DNA. Results: The 2-year OS was higher for patients who received maintenance chemotherapy than for patients without maintenance chemotherapy (78.9% vs 62.7%, P = .016). Patients with undetectable posttreatment EBV-DNA after 4-6 cycles of systemic chemotherapy (n = 73) had a higher 2-year OS than that of patients with detectable EBV-DNA (n = 68) (82.16% vs 51.45%, P = .001). For patients with undetectable posttreatment EBV-DNA, OS was better for those with maintenance chemotherapy than for those without (86.7% vs 73%, P = .027). For patients with detectable posttreatment EBV-DNA, maintenance chemotherapy did not improve outcomes (49.5% vs 55.4%, P = .824). The most common acute events were hematological toxicity, and all were tolerable and curable. Conclusions: Oral maintenance chemotherapy with S1 or capecitabine can improve OS in mNPC. Posttreatment EBV-DNA was not only an independent prognosis factor for mNPC but also can screen out beneficiaries of maintenance chemotherapy. K E Y W O R D S EBV-DNA, metastatic nasopharyngeal carcinoma, oral maintenance chemotherapy, overall survival | 2733 ZHOU et al. How to cite this article: Zhou H, Lu T, Guo Q, et al. Effects of oral maintenance chemotherapy and predictive value of circulating EBV DNA in metastatic nasopharyngeal carcinoma. Cancer Med.

Effects of locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: A real-world study

“…Well-designed prospective clinical trials are expected to explore how to optimize the treatment strategy of PMD patients. Previous studies have also confirmed that the undetectable EBV DNA levels after 4–6 weeks of chemotherapy were a good prognostic factor and a biomarker to filter out beneficiaries of maintenance chemotherapy in metastatic NPC [34] . Unfortunately, there is no standard protocol for EBV DNA detection; only a few centers have a sensitivity and specificity of >90% for EBV DNA detection [35] , [36] , [37] .…”

A systematic review and recommendations on the use of plasma EBV DNA for nasopharyngeal carcinoma

“…Another study showed that EBV DNA and some PET parameters were unfavourable prognostic factors [104]. However, one study showed that post-treatment EBV DNA titres after 1st-line platinumbased chemotherapy was not prognostic of OS [105].…”

The implications of cell‐free DNAs derived from tumor viruses as biomarkers of associated cancers

“…This cfDNA is released from NPC cells during apoptosis and can be extracted from serum and then detected by RT‐qPCR targeting the EBV BamHI‐W region 130 . In addition to screening EBV‐positive people in the population and taking preventive measures in time, this connection can also be used to monitor cancer progression and therefore evaluate the efficacy of chemotherapy of immunotherapy 131,132 or adjust treatment in time 133 . It has also been reported that shallow‐depth sequencing of cfDNA could be a promising standardized approach 134 …”