Purpose of review: In this article, we focus on the role of Epstein-Barr virus in the management of nasopharyngeal cancer, intensity-modulated radiotherapy, adjuvant and neoadjuvant chemotherapy, and targeted therapy.
Recent findings: Epstein-Barr virus DNA clearance has recently been studied for prediction of tumor response and survival. Patients with a short t1/2 of plasma Epstein-Barr virus DNA clearance had significantly higher responses and survival than those with long t1/2. Intensity-modulated radiotherapy, delivering higher doses to the tumor, results in improved local control and overall survival at lower treatment-induced toxicity. Recent reports show that re-planning during the course of radiotherapy could influence outcome and toxicity. The use of newer platinum compounds and combinations with taxanes in adjuvant and neoadjuvant setting have been investigated in phase II trials. They demonstrate acceptable toxicity profiles and promising treatment outcomes. However, antiepidermal growth factor receptor and antivascular endothelial growth factor receptor agents do not show important responses in metastatic disease and when combined with radiotherapy, toxicity is of concern.
Summary: Epstein-Barr virus DNA has a potential as a risk stratification marker. Intensity-modulated radiotherapy is standard treatment and adaptive radiotherapy with re-planning has to be considered. Uncertainties on adjuvant/neoadjuvant chemotherapy should be addressed in well designed randomized trials. Currently, the role of targeted agents is not well defined.