, 2025-04-21 07:16:00
TOPLINE:
In patients with nasopharyngeal carcinoma who received induction-concurrent (chemo)radiotherapy, persistent Epstein-Barr virus (EBV) DNA positivity or its resurgence during treatment was associated with worse survival outcomes, whereas rapid clearance of EBV DNA following induction chemotherapy was associated with better survival.
METHODOLOGY:
- Plasma EBV DNA is the most widely used biomarker for nasopharyngeal carcinoma, given its ability to indicate the presence of disease. However, research has largely focused on single timepoint measurements of EBV DNA, with limited data on continuous monitoring during induction-concurrent (chemo)radiotherapy.
- Researchers retrospectively analyzed EBV DNA clearance patterns during induction-concurrent (chemo)radiotherapy in 2203 patients with newly diagnosed nasopharyngeal carcinoma between January 2016 and December 2019.
- EBV DNA was measured at three timepoints — before and around radiotherapy initiation and within 21 days after radiotherapy completion. The results were recorded as detectable and undetectable.
- Five distinct EBV DNA clearance trajectories were identified: Type 1 (persistently undetectable; 7.3%), type 2 (rapid clearance after induction chemotherapy with subsequent stable undetectable levels; 42.8%), type 3 (incomplete clearance following induction chemotherapy but complete clearance after radiotherapy; 35.0%), type 4 (persistently detectable EBV DNA throughout treatment; 11.7%), and type 5 (resurgence; 3.3%), which followed several trajectories.
- The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival, locoregional failure–free survival, and distant metastasis failure–free survival. The median follow-up duration was 53.5 months.
TAKEAWAY:
- Patients who converted to undetectable by the end of induction chemotherapy (type 2) had the best PFS at 5 years (83.0%), outperforming all other groups, even those who converted to undetectable at the end of radiation (type 3, 76.0%) and those who were persistently undetectable (type 1, 79.4%).
- As expected, patients who remained detectable at the end of radiation (type 4) demonstrated significantly worse 5-year PFS (52.5%) than those with all other clearance trajectories — type 1 (79.4%), type 2 (82.9%), type 3 (75.9%), or type 5 (72.5%; P < .05 for all).
- Similar trends were observed for overall survival, locoregional failure–free survival, and distant metastasis failure–free survival. For instance, 5-year overall survival rates for those who converted to undetectable by the end of induction chemotherapy (type 2) was highest — 89.0% vs 86.3% (type 1), 87.1% (type 2), and 68.3% (type 4).
IN PRACTICE:
“Our findings underscore the importance of dynamic EBV DNA monitoring for individualized treatment of patients with nasopharyngeal carcinoma,” the researchers concluded. “The temporal clearance pattern EBV DNA can offer additional prognostic insights beyond single timepoint measurements in [nasopharyngeal carcinoma]. Persistent EBV DNA positivity and resurgence during treatment are associated with poorer outcomes, whereas rapid clearance following [induction chemotherapy] is indicative of a favorable prognosis.”
SOURCE:
The study, led by Zongwei Huang, MD, PhD, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China, was published online in International Journal of Radiation Oncology – Biology – Physics.
LIMITATIONS:
The exclusion of patients who did not undergo induction chemotherapy might have led to selection bias. Differences in treatment intensity and patient stratification could have affected clinical outcomes. As this study was conducted at a single center, results might not be applicable to a broader population.
DISCLOSURES:
The study was supported by grants from the Fujian Provincial Clinical Research Center for Cancer Radiotherapy and Immunotherapy, National Clinical Key Specialty Construction Program, Fujian Clinical Research Center for Radiation and Therapy of Digestive, Respiratory and Genitourinary Malignancies, and other organizations. The authors reported having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
