Analysis of Plasma Epstein–Barr Virus DNA and Clinical Outcomes to Pembrolizumab or Chemotherapy in Recurrent/Metastatic Nasopharyngeal Cancer in KEYNOTE-122
Issued Date
2026-02-01
Resource Type
eISSN
20457634
Scopus ID
2-s2.0-105029280480
Journal Title
Cancer Medicine
Volume
15
Issue
2
Rights Holder(s)
SCOPUS
Bibliographic Citation
Cancer Medicine Vol.15 No.2 (2026)
Suggested Citation
Chan A.T.C., Lee V.H.F., Hong R.L., Ahn M.J., Chong W.Q., Spreafico A., Kim S.B., Ho G.F., Caguioa P.B., Ngamphaiboon N., Swaby R.F., Wei B., Webber A.L., Kang J., Gumuscu B., Yuan J., Siu L.L. Analysis of Plasma Epstein–Barr Virus DNA and Clinical Outcomes to Pembrolizumab or Chemotherapy in Recurrent/Metastatic Nasopharyngeal Cancer in KEYNOTE-122. Cancer Medicine Vol.15 No.2 (2026). doi:10.1002/cam4.71496 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114952
Title
Analysis of Plasma Epstein–Barr Virus DNA and Clinical Outcomes to Pembrolizumab or Chemotherapy in Recurrent/Metastatic Nasopharyngeal Cancer in KEYNOTE-122
Author's Affiliation
The University of Hong Kong
Chinese University of Hong Kong
Universiti Malaya
Merck & Co., Inc.
National Taiwan University Hospital
Asan Medical Center
Samsung Medical Center, Sungkyunkwan university
Princess Margaret Cancer Centre
Ramathibodi Hospital
University of Santo Tomas, Manila
National University Cancer Institute
Chinese University of Hong Kong
Universiti Malaya
Merck & Co., Inc.
National Taiwan University Hospital
Asan Medical Center
Samsung Medical Center, Sungkyunkwan university
Princess Margaret Cancer Centre
Ramathibodi Hospital
University of Santo Tomas, Manila
National University Cancer Institute
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Plasma Epstein–Barr virus (EBV) DNA has clinical utility for prognosis, recurrence, surveillance, and treatment response in nasopharyngeal carcinoma (NPC). This exploratory analysis evaluated associations between plasma EBV DNA load and clinical outcomes in participants treated with pembrolizumab or chemotherapy in the phase 3 KEYNOTE-122 trial (NCT02611960). Methods: Participants with platinum-pretreated, histologically confirmed, EBV-positive, recurrent/metastatic NPC were randomly assigned (1:1) to pembrolizumab 200 mg intravenously every 3 weeks (≤ 35 cycles) or standard of care (SOC; investigator's choice of capecitabine, gemcitabine, or docetaxel). Associations between baseline plasma EBV DNA load as a continuous variable and plasma EBV DNA fold change at cycle 2 day 1 (C2D1), with clinical outcomes (progression-free survival [PFS], overall survival [OS], and objective response rate [ORR]) were evaluated within each treatment arm. Nominal significance was prespecified at 0.05 for 1-sided p values. Results: Of 228 treated participants, 215 (94.3%) had evaluable baseline plasma EBV DNA load data (pembrolizumab, 111; SOC, 104). Baseline plasma EBV DNA load was negatively associated with PFS and OS for pembrolizumab and SOC (both p < 0.005) but not ORR (p = 0.105, pembrolizumab; p = 0.473, SOC). Larger decreases in plasma EBV DNA load at C2D1 relative to baseline were associated with improved PFS, OS, and ORR for pembrolizumab and SOC (p ≤ 0.005). Conclusions: Higher baseline plasma EBV DNA load was negatively associated with outcomes in participants with NPC treated with pembrolizumab or SOC. These findings provide additional support for plasma EBV DNA as a prognostic biomarker for NPC. Trial Registration: ClinicalTrials.gov, NCT02611960.