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The aim of this case study is to discuss the medical nutrition therapy in oncology patient with head and neck cancer. This case illustrates the importance of a thorough medical nutrition assessment and the need for a change in the dietary approaches. A 28-year-old, married woman presented with tachypnea wheezing and diagnosed with Metastatic Nasopharyngeal Carcinoma (NPC) (T4N3aMx) with Acute Exacerbation of Bronchial Asthma (AEBA). She was first diagnosed with NPC (cT2N3M0) on August 2016 and completed concurrent chemo radiation therapy (CCRT) on November 2016. During admission on the 7th to 14th March 2017, patient was planned for palliative chemotherapy. Her weight was 26 kg with height 1.53 m2 indicates severely underweight with BMI 11.1 kg/m² and had severe weight loss of 15 % in a month. Estimated intake in the ward was 310 kcal/day (5.8 kcal/kg/day) and protein intake 5.9 g/day (0.1 g/kg/day). Nutrition diagnosis showed inadequate protein-energy intake (NI-5.2) related to decrease ability to consume sufficient protein and energy (swallowing difficulty due to NPC) as evidenced by coughing when swallowing and estimated energy intake was 57 % requirement and 37 % protein intake from requirement. The energy requirement was targeted at 35 kcal/kg/d (1855 kcal/day) in order to promote weight gain and to prevent any further weight loss as patient is in catabolic state. Thus, the protein requirement is targeted between 1.2g/kg-1.5g/kg with a total of 63.6-79.5g protein per day. Nutritional management via nasogastric feeding was planned in order to optimize patient’s energy and protein intake but initially refused by patient. After few follow-ups, patient then agreed with the proposed feeding plan via nasogastric feeding. Three hourly feeding with complete and balanced formula was started slowly and increase gradually until meet optimal intake as to monitor patient’s tolerance and to avoid refeeding syndrome. Patient’s weight increased from 26 to 27 kg (1 kg @ 4% weight increment within 8 days) and able to achieve 93% energy requirement with 1728 kcal/day @ 33kcal/kg IBW/day and 100 % protein requirement with 72 g/day @ 1.4 g/kg IBW/day. Discharge feeding plan was given to patient for continuation of care at home in order to promote further weight gain and to improve patient’s quality of life especially for patients who are on treatment of nasopharyngeal carcinoma. The side effect of treatment might cause taste sensation, difficulty in opening the mouth, dysphagia, odynophagia, mucositis, xerostamia and nausea that will worsen the patient’s nutritional status. Therefore, optimization of energy and protein intake with nasogastric feeding is very crucial as to promote weight gain and improving overall patient well-being.