【Abstract】 Objective Advanced nasopharyngeal carcinoma (NPC) that progresses after treatment is typically associated with a poor prognosis, and a significant proportion of patients fail to benefit from standard therapeutic regimens. Therefore, this study aims to explore novel combination treatment strategies by analyzing the short- and long-term efficacy and safety of adding anti-angiogenic agents to the PD-1 inhibitor plus chemotherapy regimen for patients with recurrent or metastatic NPC in non-endemic areas . Methods A retrospective analysis was conducted on 171 R/M NPC patients who were diagnosed by pathology or imaging at Jiangsu Cancer Hospital from January 2019 to December 2024. The study group received PD-1 inhibitors combined with chemotherapy and anti-angiogenic agents, while the control group received PD-1 inhibitors combined with chemotherapy. Patient data included basic clinical information, objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free surv