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The following is a summary of “Efficacy of adjuvant chemotherapy in patients with different midpoint-radiotherapy Epstein-Barr virus DNA plasma loads,” published in the July 2024 issue of Oncology by Chen et al.

This study aimed to evaluate the efficacy of adjuvant chemotherapy (AC) in patients with varying midpoint-radiotherapy (mid-RT) Epstein-Barr virus (EBV) DNA plasma levels for locoregionally advanced nasopharyngeal carcinoma (NPC), offering insights for clinical decision-making regarding the use of AC.

A cohort of 675 consecutive patients diagnosed with stage III–IVa NPC participated in the study. All patients underwent concurrent chemoradiotherapy (CCRT), with some receiving induction chemotherapy AC, or both, while others were only observed post-CCRT. The primary endpoint was progression-free survival (PFS).

Among the 675 patients, 248 (36.7%) received AC, and 427 (63.3%) were observed following CCRT. Detectable mid-RT EBV DNA levels were found in 149 (22.1%) patients, while 526 (77.9%) had undetectable levels. Those with detectable mid-RT EBV DNA experienced worse 5-year PFS than those with undetectable levels (74.8% vs. 81.9%, P = 0.045). For patients with detectable mid-RT EBV DNA, the AC group exhibited significantly better 5-year PFS than the observation group (82.8% vs. 66.8%; HR, 0.480; 95% CI 0.250–0.919, P = 0.027). Multivariate analyses confirmed that the treatment approach (AC vs. observation) was an independent prognostic factor for PFS (HR, 0.37; 95% CI 0.19–0.74, P = 0.005). However, in patients with undetectable mid-RT EBV DNA, the AC group showed no significant survival benefit compared to observation (5-year PFS: HR 0.873, 95% CI 0.565–1.349, P = 0.52).

In conclusion, AC appears to reduce the risk of disease progression in patients with detectable mid-RT EBV DNA, indicating that AC is particularly beneficial for patients at a high risk of treatment failure.

Source: sciencedirect.com/science/article/abs/pii/S1368837524002562