Nasopharyngeal carcinoma (NPC) is a human malignancy with well-established association with Epstein-Barr virus (EBV) infection. Due to the concealed anatomical location of nasopharynx and the absence of early-stage clinical symptoms, most patients are diagnosed at a relatively advanced stage. EBV-related biomarkers, such as plasma EBV DNA and serum EBV antibodies, demonstrate outstanding sensitivity and specificity in the early detection of NPC. Moreover, plasma EBV DNA also serves as a useful tool for prognostic prediction of patients with NPC. Although current standard therapies have significantly improved the survival of patients with locoregionally advanced NPC, the establishment of personalized treatment plans remains challenging, and a subset of patients still experience disease progression even after definitive treatment. Plasma EBV DNA has shown great potential in guiding adaptive treatment of NPC, enabling optimum efficacy while minimizing treatment associated adverse effects. Additionally, EBV-targeted therapies, including cell therapies and small-molecule drugs activating anti-virus immune response or directly targeting EBV life cycle, represent promising approaches for these patients. In this review, we systematically summarized recent advances in EBV-targeted screening, prognostic prediction, adaptive treatment, and novel treatment strategies for NPC, discussed the strengths and limitations of these approaches and outlined future research directions in these fields.
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