The role of Epstein-Barr virus in nasopharyngeal carcinoma: a case report
Ana R. Teixeira 1 
, Cláudia Agostinho 1, Marta Pina 1
1 Department of Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
*Correspondence: Ana R. Teixeira. Email: anaraquel.teixeira9@gmail.com
Abstract
Nasopharyngeal carcinoma (NPC) has a strong association with Epstein-Barr virus (EBV) infection. We present the case of a 45-year-old male with non-keratinizing NPC cT1N2M0 and serum EBV DNA positivity (1.4 × 103 copies/mL) in April 2022. He underwent three cycles of cisplatin/gemcitabine until October 2022 and was submitted to chemoradiotherapy, obtaining a partial imaging response and undetectable EBV DNA. In April 2023, he presented with bone and lymph node metastases, with EBV DNA < 250 copies/mL. He underwent palliative chemotherapy with carboplatin/paclitaxel and, after six cycles of treatment, showed concomitant disease progression with an increase in EBV viral load. He began treatment with nivolumab but maintained an increase in EBV DNA, and after two cycles, disease progression was confirmed, and rechallenge with gemcitabine was proposed. He obtained a partial response and EBV DNA < 250 copies/mL. Thus, monitoring plasma EBV DNA can play a role in surveillance and in assessing the response to Nicole Conradie therapy.
