Potential pitfalls in incorporating plasma Epstein‐Barr virus DNA in the management of nasopharyngeal carcinoma

Abstract

Background: This study identifies potential pitfalls in incorporating plasma Epstein-Barr virus (EBV) DNA into the management of nasopharyngeal carcinoma (NPC).Methods: A total of 208 NPC patients without distant metastasis who received radical treatment and had measurements of EBV DNA at baseline, 8 weeks and 26 weeks postradiotherapy were analyzed. Prognostic and predictive values at each time-point were compared.Results: Risk stratification by pretreatment level failed to identify a poor prognostic group. Detectable EBV DNA at 8 weeks and 26 weeks postradiotherapy were both associated with significantly poorer 5-year disease-free survival (HR 0.30, P < .001 and HR 0.03, P < .001, respectively) and overall survival (HR 0.27, P = .009 and HR 0.03, P < .001, respectively). Eighty percentage had detectable EBV DNA at recurrence (53.3% for local only, 100% for regional only, and 100% for distant failure).Conclusions: Posttreatment EBV DNA, particularly at 26 weeks post-radiotherapy, has high prognostic and predictive values. Surveillance endoscopy/ imaging are recommended for the detection of local recurrence. K E Y W O R D Sbiomarker, nasopharyngeal carcinoma, pitfalls, plasma EBV DNA, prognostication

Prognostic Value of Plasma Epstein-Barr Virus DNA Levels Pre- and Post-Neoadjuvant Chemotherapy in Patients With Nasopharyngeal Carcinoma

“…Additionally, post-radiotherapy EBV DNA levels in the plasma of patients with NPC predicted locoregional failure, distant metastasis, and death ( 20 ). Post-treatment plasma EBV DNA levels also predicted distant metastasis ( 21 ) and tumor recurrence ( 22 ); thus, additional treatment in patients with high post-treatment EBV DNA levels may prevent relapse ( 14 ). Many NPC prognostic models are based on the EBV characteristics and serological indicators ( 19 , 23 , 24 ).…”

Predictive Value of ERCC1 mRNA Level and Pretreatment EBV-DNA Virus Load in Stage II Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy with Concurrent Cisplatin

“…Several studies have shown that EBV-DNA levels in advanced stage NPC are signi cantly higher than those in stage I and II NPC [31][32][33]. Du et al observed that the level of EBV-DNA was correlated with age,…”

The Clinical Value of Plasma Epstein-Barr Virus DNA as a Tumor Marker in Nasopharyngeal Carcinoma: Prognostic? Yes, But How Can We Best Use It?

“…It is, however, relatively common in Southeast Asian countries, and in endemic regions of China, it reaches an incidence of around 20/100,000 2 . Epstein-Barr Virus (EBV) infection is an etiologic factor in the development of endemic, nonkeratinizing (World Health Organization type II/III) NPC, 3 and plasma EBV-DNA levels at different time points in treatment have been correlated with prognostic endpoints, including distant metastasis, locoregional recurrence, and death 4–14 . Prognostic models using EBV-DNA levels have been devised to supplement TNM staging, and EBV-DNA levels are used in some institutions to monitor disease recurrence during posttreatment surveillance 4,15 .…”

“…2 Epstein-Barr Virus (EBV) infection is an etiologic factor in the development of endemic, nonkeratinizing (World Health Organization type II/III) NPC, 3 and plasma EBV-DNA levels at different time points in treatment have been correlated with prognostic endpoints, including distant metastasis, locoregional recurrence, and death. [4][5][6][7][8][9][10][11][12][13][14] Prognostic models using EBV-DNA levels have been devised to supplement TNM staging, and EBV-DNA levels are used in some institutions to monitor disease recurrence during posttreatment surveillance. 4,15 The role of EBV-DNA in NPC is an area of extensive research, with scores, if not hundreds, of publications on the subject in the last 20 years.In the current issue of The Cancer Journal, He and colleagues report on the prognostic value of EBV-DNA levels before, after, and in long-term follow-up after treatment for NPC.…”