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Nasopharyngeal carcinoma (NPC) is an Epstein-Barr virus (EBV)-associated malignancy. Concurrent chemoradiation (CCRT) or systemic chemotherapy is the mainstay of first-line treatment of NPC. A recent study demonstrated a measurable response of metastatic NPC treated with pembrolizumab, an immune checkpoint inhibitor. Herein, we report the case of a 54-year-old woman with locally advanced NPC who had a poor response to platinum-based chemotherapy and could not tolerate CCRT. She underwent pembrolizumab treatment with a lower dosage than that previously reported, during which her primary and metastatic neck tumors markedly resolved. A persistent response after the treatment course was also noted. Therefore, pembrolizumab could be considered to be a subsequent treatment for patients with pre-treated locally advanced NPC. Keywords: Nasopharyngeal carcinoma, Pembrolizumab