Plasma Epstein-Barr virus DNA level strongly predicts survival in metastatic/recurrent nasopharyngeal carcinoma treated with palliative chemotherapy

Abstract

BACKGROUND: Plasma Epstein-Barr virus (EBV) DNA is widely used in screening, monitoring, and prediction of relapse in nonmetastatic nasopharyngeal carcinoma (NPC). However, data regarding utility of plasma EBV DNA in metastatic NPC are rare. The current study was to test the prognostic implication of plasma EBV DNA level in metastatic/recurrent NPC patients treated with palliative chemotherapy. METHODS: Plasma EBV DNA level was measured at baseline and thereafter at the start of each treatment cycle in 127 histologically proven metastatic/recurrent NPC patients treated with palliative chemotherapy. Correlations of pre-treatment and post-treatment plasma EBV DNA levels to survival and response were analyzed. RESULTS: Patients with a low pre-treatment plasma EBV DNA level (<median) had significantly better survival than those with a high pre-treatment plasma EBV DNA level (!median). Patients with a post-treatment plasma EBV DNA decline to an undetectable level had better survival and better tumor response compared with those with a sustained detectable post-treatment plasma EBV DNA level. The early decrease of posttreatment plasma EBV DNA to an undetectable level after 1 cycle of chemotherapy was associated with significantly increased survival. Patients with low pre-treatment plasma EBV DNA level and undetectable post-treatment plasma EBV DNA showed a favorable prognosis (5-year overall and progression-free survival of 50.6% and 21.7%, respectively). CONCLUSIONS: Plasma EBV DNA is of predictive value for prognosis in metastatic/recurrent NPC patients undergoing palliative chemotherapy. The pre-treatment plasma EBV DNA level as well as the early decrease of plasma EBV DNA after chemotherapy enabled easy and early discrimination between patients who will and those who will not benefit from continued treatment.

Recurrent Nasopharyngeal Carcinoma: A Clinical Dilemma and Challenge

“…An et al 39 showed that the plasma ebv dna concentration could predict prognosis in recurrent or metastatic npc after palliative chemotherapy. Although patients with early T-stage tumours, a long latency to recurrence, and younger age might potentially be curable, most cases of rnpc are diagnosed at an advanced stage, and the optimal treatment decisions for those patients remain challenging.…”

Prognostic role of plasma Epstein-Barr virus DNA load for nasopharyngeal carcinoma: a meta-analysis

“…The meta-analysis found that high pre-treatment levels of EBV DNA had good value as a prognostic indicator of survival and disease outcomes in patients with NPC. Most of the studies included in this meta-analysis found that increased levels of EBV DNA prior to treatment was associated with poor overall survival [13,[28][29][30][32][33][34][35][36][37]39,40]. Of the studies that evaluated the other outcomes, high pre-treatment EBV DNA levels was also associated with increased risk for disease progression, relapse, recurrence, and distant metastasis.…”

“…The remaining 57 were fully evaluated for inclusion and 41 were eliminated for not reporting the outcomes of interest, reporting data that could not be pooled for a meta-analysis, not being relevant or reporting findings from a study that was already included. Sixteen studies were included in the study with a total of 7698 patients [12,13,[28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Three of the studies were retrospective in design and the remaining 13 studies were prospective (Table 1).…”

The Biology and Clinical Utility of EBV Monitoring in Blood

“…The association between high pretreatment plasma EBV DNA levels and inferior OS has also been demonstrated in NPC cohorts using other cutoffs (Chai et al 2012). Pre-treatment plasma EBV DNA levels have been shown to be a prognostic marker for treatment response and distant metastasis-free survival An et al 2011;Hsu et al 2012;Wang et al 2010;Leung et al 2003). In one study, the probability of distant failure in NPC patients was significantly higher in those with pre-treatment EBV DNA copy number of >4000 copies/mL plasma (Leung et al 2003).…”