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This study retrospectively analyzed the efficacy of immunotherapy regimens in RM\u2010NPC that failed at least first\u2010line therapy. From February 2014 to August 2023, a total of 794 patients with RM\u2010NPC were included in this study, of which 75 patients received anti\u2010programmed cell death protein\u20101 (PD\u20101) only (P), 130 patients received anti\u2010PD\u20101 plus antiangiogenic therapy (AP), 210 patients received anti\u2010PD\u20101 plus single\u2010agent chemotherapy (C1P), 276 patients received anti\u2010PD\u20101 plus two\u2010agent chemotherapy (C2P), and 103 patients received anti\u2010PD\u20101 plus antiangiogenic plus chemotherapy (CAP). Progression\u2010free survival (PFS), overall survival (OS), and adverse events were analyzed. In the inverse probability of treatment weighting (IPTW) cohort, median follow\u2010up time was 28.7 months, median PFS in the P, AP, C1P, C2P, and CAP were 3.6, 8.5, 7.6, 12.7, and 16.3 months, respectively. PFS was significantly better in the CAP, C2P, C1P, and AP than P (\n                    <jats:italic>p<\/jats:italic>\n                    values of &lt;.001, &lt;.001, .026, and .002). Median OS in the P, AP, C1P, C2P, and CAP were 35.8, 46.6, 50.9, 50.6, and 47.2 months, respectively. Grade 3\u20134 treatment\u2010related adverse events (TRAEs) occurred in 288 patients, with rates significantly higher in the C1P than AP (34.3% vs. 16.9%) and higher in the C2P than CAP (54.0% vs. 42.7%). These results showed that, in RM\u2010NPC patients who failed at least first\u2010line therapy, anti\u2010PD\u20101 combination therapy was associated with improved PFS compared with anti\u2010PD\u20101 monotherapy.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70399","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:51:49Z","timestamp":1772992309000},"page":"224-233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of \u22652 lines immunotherapy regimens for recurrent\/metastatic nasopharyngeal carcinoma"],"prefix":"10.1002","volume":"159","author":[{"given":"Lan","family":"Peng","sequence":"first","affiliation":[{"name":"Sun Yat\u2010sen University Cancer Center State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer  Guangzhou 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Guangdong Provincial Clinical Research Center for Cancer  Guangzhou China"},{"name":"Department of Nasopharyngeal Carcinoma Sun Yat\u2010sen University Cancer Center  Guangzhou China"},{"name":"Nasopharyngeal Cancer Center The Fifth Affiliated Hospital of Sun Yat\u2010sen University  Zhuhai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiong\u2010Lin","family":"Liang","sequence":"additional","affiliation":[{"name":"Sun Yat\u2010sen University Cancer Center State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer  Guangzhou China"},{"name":"Department of Nasopharyngeal Carcinoma Sun Yat\u2010sen University Cancer Center  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si\u2010Yuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Sun Yat\u2010sen University Cancer Center State Key Laboratory 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