Plasma EBV DNA
Fragments of Epstein-Barr virus DNA in the blood that measure nasopharyngeal carcinoma: used to screen healthy people in endemic regions, to stage, to decide who needs extra treatment after radiotherapy, and to detect relapse.
Quantitative PCR for EBV BamHI-W or EBNA1 sequences in plasma (Lo, 1999) correlates with tumour burden and stage in EBV-associated NPC. Uses: (1) screening: a two-stage plasma EBV DNA test in 20,174 Hong Kong men detected NPC at earlier stage with better survival (Chan, NEJM 2017); (2) prognosis: pretreatment level is independent of TNM and incorporated in proposed staging; (3) response: detectable EBV DNA after chemoradiation identifies high-risk patients who benefit from adjuvant chemotherapy (NRG-HN001 trial design; Chen 2021 capecitabine); (4) surveillance: rising levels precede clinical relapse by months. Standardisation across laboratories (harmonised assays) remains a challenge; NGS-based fragmentomic assays improve specificity. It is the template for ctHPV DNA in oropharyngeal cancer.
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