Plasma Epstein-Barr virus DNA analysis for personalised management of nasopharyngeal carcinoma—current opportunities and challenges

Abstract

Plasma Epstein-Barr virus (EBV) DNA is a well-established tumour biomarker of nasopharyngeal carcinoma (NPC). There is ample evidence to support the clinical utility of plasma EBV DNA analysis for screening, prognostication and monitoring of recurrence of NPC. To fully realise its potential, researchers have been actively exploring the utility for guidance of personalised NPC treatment. There are ongoing studies to define high-risk group based on plasma EBV DNA results for subsequent escalation of treatment and the clinical outcome including survival would then be evaluated. In this review, we would summarise the current clinical indications of plasma EBV DNA analysis for NPC management. In particular, we would discuss the potentials and current challenges of using plasma EBV DNA to guide treatment for NPC. In addition, the molecular characteristics of plasma EBV DNA (quantitative, size and methylation profiles) from NPC samples have been recently revealed. In screening, some subjects harbour EBV DNA in plasma but do not have NPC. There are distinct molecular profiles of plasma EBV DNA between NPC and nonNPC subjects. Such knowledge has formed the basis of newer generation of plasma EBV DNA-based test, compared to conventional polymerase chain reaction-based assay, with enhanced diagnostic performance for the purpose of screening.