From the Guidelines
Yes, Epstein-Barr virus (EBV) is linked to several types of cancer, including nasopharyngeal carcinoma, as established by the most recent and highest quality study 1.
Key Points
- EBV has been established as a causative agent in multiple malignancies including Burkitt lymphoma, Hodgkin lymphoma, certain non-Hodgkin lymphomas, nasopharyngeal carcinoma, and some gastric cancers.
- The virus infects B cells and epithelial cells, where it can remain dormant for years, and in most people, EBV infection causes no long-term problems, as the immune system keeps the virus under control.
- However, in some individuals, genetic factors, immune suppression, or environmental co-factors can allow EBV to contribute to cancer development, as noted in a study published in the Journal of the American College of Radiology 1.
- The virus promotes oncogenesis through various mechanisms including the expression of viral proteins that interfere with cell cycle regulation, inhibit apoptosis, and promote cell proliferation, as discussed in a guideline published in the Annals of Oncology 1.
- EBV also produces microRNAs that can alter host cell gene expression, and while EBV is widespread (infecting over 90% of adults worldwide), EBV-associated cancers are relatively rare, indicating that additional factors beyond viral infection are necessary for cancer development, as highlighted in a study published in The Lancet Oncology 1.
Clinical Implications
- The link between EBV and cancer has significant implications for the diagnosis, treatment, and prevention of EBV-associated cancers.
- Accurate staging of the primary tumor, including evaluation of involvement of osseous structures and extension into adjacent soft tissues, is crucial for effective management of nasopharyngeal carcinoma, as emphasized in a study published in the Journal of the American College of Radiology 1.
- Plasma EBV DNA measurement can be a useful tool in the management of nasopharyngeal carcinoma, particularly in resource-constrained settings, but it should not replace nasoendoscopy and tumour biopsy, as recommended in a guideline published in The Lancet Oncology 1.
From the Research
EBV and Cancer
- Epstein-Barr Virus (EBV) is associated with several types of cancer, including Burkitt's lymphoma, post-transplant lymphoproliferative disorders, and nasopharyngeal carcinoma 2.
- EBV can infect epithelial cells in the nasopharynx and is a co-factor for the development of nasopharyngeal carcinoma 2.
- The virus has oncogenic potential, which underlies its role in various cancers, including lymphoma in HIV-infected patients 2.
Treatment of EBV-Associated Cancers
- Current treatments for EBV-associated malignancies include radiotherapy and chemotherapy 2.
- Adoptive therapy through infusions of human leukocyte-associated antigen-matched EBV cytotoxic T cells may form a novel strategy for both prophylaxis and treatment of EBV-induced lymphoproliferative disorders 2.
- Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with or without radiotherapy is a treatment approach for primary mediastinal large B-cell lymphoma, which has shown promising results 3, 4.
- The addition of rituximab to the treatment regimen for Burkitt's lymphoma may be associated with a significant survival benefit 5.
Vaccine Development and Immune Cell Therapy
- An EBV prophylactic vaccine that induces neutralizing antibodies holds great promise for the prevention of EBV-associated diseases 6.
- Immunization with the combination of EBV envelope proteins, including gH/gL, gB, and gp350, has shown increased synergistic EBV neutralizing activity compared to immunization with individual proteins 6.
- Therapeutic EBV vaccines have been tested clinically, with encouraging results, and immune cell therapy has emerged as a promising treatment for EBV-associated cancers 6.