TPC Combined With Cadonilimab VS. TPC Alone in Anti-PD-1 Resistant Recurrent or Metastatic Nasopharyngeal Carcinoma

Inclusion Criteria:

• 1.Histopathological diagnosis confirmed as non-keratinizing nasopharyngealcarcinoma.

2.Confirmed diagnosis of metastatic or recurrent nasopharyngeal carcinoma, notsuitable for radical local treatment.

3.Patients who have failed first-line or subsequent anti-PD-1 antibody immunotherapy (either monotherapy or combination therapy).

4.Age between 18 and 70 years. 5.Generally good condition, ECOG score of 0-1, with alife expectancy of ≥3 months.

6.At least one measurable lesion (according to RECIST 1.1); lesions that have beenpreviously irradiated can be considered target lesions if imaging diagnosis clearlyshows progression and they are measurable.

7.Adequate organ and bone marrow function, specifically hemoglobin (HGB) ≥ 80 g/L,white blood cells (WBC) ≥ 4×10^9/L, and platelets (PLT) ≥ 75×10^9/L. Liver function:total bilirubin (TBIL) < 1.5 times the upper limit of normal (ULN), alanineaminotransferase (ALT) and/or aspartate aminotransferase (AST) < 2.5 times the ULN;serum albumin (ALB) ≥ 28 g/L; if the patient has liver metastases, ALT or AST < 5×ULN; if the patient has liver or bone metastases, alkaline phosphatase (AKP) < 5×ULN. Prothrombin time (PT) international normalized ratio/PTT < 1.5 times the ULN;cardiac function requirement is left ventricular ejection fraction (LVEF) ≥ 50%.

7.Voluntarily participate and sign the informed consent form, and accept and complywith the study protocol, laboratory tests, follow-ups, etc.

8.Female subjects of childbearing potential and male subjects with fertile partnersmust agree to use effective contraception (such as condoms, regularly prescribedcontraceptive pills, etc.) from screening until 6 months after the last treatment.

Exclusion Criteria:

• 1.History of hypersensitivity to monoclonal antibodies. 2.Time interval of less than 6 months from the last first-line TPC chemotherapy.

3.Known history of interstitial pneumonia. 4.Severe infection occurring within 4weeks prior to the first administration, including but not limited to complicationsrequiring hospitalization, sepsis, or severe pneumonia.

5.Patients who have used aspirin (>325 mg/day) or dipyridamole, ticlopidine,clopidogrel, and cilostazol within 3 weeks prior to medication, or anticoagulantsrequiring INR monitoring (such as warfarin), or those who have received any bloodcomponents and cell growth factor support therapy within 1 week prior to medication.

6.Active infections requiring systemic treatment. 7.Active hepatitis B (HBV-DNA ≥ 1000 IU/ml) that persists despite treatment, excluding those with cured hepatitis C;significant clinical bleeding symptoms or a clear bleeding tendency within 1 monthprior to medication.

8.Received the last radiotherapy or antitumor treatment within 3 weeks prior to thefirst administration.

9.Known history of active tuberculosis or autoimmune diseases. 10.Patients with HIVinfection. 11.Presence of other uncontrolled malignancies. 12.Abnormal function ofmajor organs such as the heart, brain, or lungs, or clinical significance ofhydronephrosis, ascites, pericardial effusion, or those undergoing thrombolytictherapy.

13.Pregnant or breastfeeding women. 14.Individuals with personality or mentaldisorders, or those lacking full civil capacity or having limited civil capacity.

15.Currently participating in an interventional clinical study treatment, or havingreceived treatment with other investigational drugs within 4 weeks prior to thefirst administration.