Circulating Epstein-Barr virus DNA as a precision biomarker in nasopharyngeal carcinoma: from risk stratification to real-time treatment adaptation and disease surveillance.

PURPOSE OF REVIEW: Nasopharyngeal carcinoma (NPC) is a virally driven malignancy with marked biological heterogeneity that is inadequately captured by anatomical staging alone. Circulating plasma Epstein-Barr virus (EBV) DNA has emerged as an archetypal biomarker with expanding roles across the disease continuum. This review summarizes the recent evidence that had expanded plasma EBV DNA utility beyond prognostication to real-time treatment adaptation and disease surveillance.

RECENT FINDINGS: Contemporary studies had demonstrated that baseline EBV DNA refines risk stratification beyond TNM staging and identifies patients suitable for treatment escalation or de-escalation. Longitudinal on-treatment EBV DNA kinetics revealed distinct response phenotypes, with persistent detection during therapy indicative of treatment-resistant disease. Emerging risk-adapted therapeutic (RAT) strategies that tailor systemic therapy based on EBV DNA clearance have shown promising improvements in disease control. In the posttreatment setting, EBV DNA may guide surveillance protocols, and complement radiological investigations.

SUMMARY: EBV DNA is evolving from a static biomarker into an operational tool for precision oncology in NPC. Its integration enables biologically informed risk stratification, dynamic response assessment, and adaptive treatment strategies, with important implications for personalized management of NPC.