NPC02, a 42 year-old NPC patient with bone metastasis, had received five different lines of palliative chemotherapy before gemcitabine (GEM) was prescribed. Allergy to cisplatin was found during treatment with the third chemotherapy regimen (FMP); thus, cisplatin was subsequently omitted. A. Plasma EBV-DNA load reflecting the clinical response of the patient. Plasma EBV-DNA load decreased after treatment with GEM, which was also shown to be effective in the corresponding NPC02 PDX system. The patient died from aspiration pneumonia with septic shock 3 months after the last plasma EBV-DNA detection. Whole-body bone scan before B. and after C. GEM treatment at 3-month intervals, revealing stable disease (hot spots in right chest wall ribs in (C) are due to trauma). Abbreviations: PULB, cisplatin, tegafur/uracil, leucovorin, and bleomycin; MUB, methotrexate, tegafur/uracil, and bleomycin; FMP, tegafur/uracil, mitomycin-C, and cisplatin; FM, tegafur/uracil and mitomycin-C; VP+U, etoposide and tegafur/uracil; FA, tegafur/uracil and doxorubicin.