Patience.

Close to 30% of patients who receive chemoradiation for nasopharyngeal carcinoma (NPC) have persistent plasma EBV DNA 6 weeks after treatment. A large randomized trial showed that adjuvant chemotherapy did not improve recurrence free survival in this high risk population. However a secondary analysis of that trial finds that 51% of patients with persistent EBV DNA at 6 weeks will actually clear it by 6 months. Do those patients go on to do well? Yes, they have a significantly higher rate of 5-year PFS (86%) compared to those with detectable EBV at 6 months (23)%—independent of adjuvant chemotherapy. In fact, their 5-year PFS is comparable to those who have undetectable EBV DNA immediately after treatment. Unfortunately, that means outcomes are worse for those with persistent EBV DNA at 6 months. | Hui, Clin Cancer Res 2021