Objective：To evaluate the short-and long-term efficacy and safety of adding anti-angiogenic agents to programmed cell death protein 1（PD-1）inhibitors combined with chemotherapy in patients with recurrent or metastatic nasopharyngeal carcinoma（R/M NPC）from non-endemic regions，with the aim of exploring novel combination treatment strategies. Methods：A retrospective analysis was conducted on 171 patients with R/M NPC confirmed by pathology or imaging at Jiangsu Cancer Hospital between January 2019 and December 2024. Patients were divided into two groups：the combination group received anti-angiogenic agents plus PD-1 inhibitors and chemotherapy，while the non - combination group received PD - 1 inhibitors and chemotherapy alone. Clinical data including objective response rate（ORR），disease control rate（DCR），overall survival（OS），progression -free survival（PFS），and treatment - related adverse events were collected. The chi - square test was used to compare baseline characteristics，short - term efficacy，and adverse events between groups. Survival outcomes were analyzed using the Kaplan-Meier method and compared with the log-rank test. Prognostic factors for PFS were evaluated via multivariate Cox regression，and a forest plot was generated. Results：The median follow-up duration was 31.7（2.8-61.8）months. The ORR in the combination group was significantly higher than that in the non-combination group（69.1% vs. 49.5%，P = 0.011）. The median PFS was 28.9 months in the combination group versus 14.2 months in the non - combination group（P=0.025）. No statistically significant difference in OS was observed between the two groups（P=0.203）. Subgroup analysis revealed that the survival benefit of combination therapy was more pronounced in patients aged ≤50 years，without pre - treatment anemia or liver metastasis，with positive EBV - DNA，and those who had not previously received immunotherapy or received ≥2 lines of therapy（P ＜ 0.05）. Apart from rash and anemia，the incidence of other adverse events did not differ significantly between the groups. Conclusion：Combination therapy exhibits favorable antitumor activity and an acceptable safety profile in nonendemic R/M NPC patients who are younger，have no pre-treatment anemia，are EBV-DNA positive，and failed first-line chemotherapy.