Chidamide in Combination With Toripalimab and Anlotinib in Recurrent/Metastatic Nasopharyngeal Carcinoma.

Exclusion Criteria

• •1. Known severe hypersensitivity (≥Grade 3) to any monoclonal/polyclonal antibody, chidamide, or anlotinib components.
• •2. Necrotic lesions identified within 4 weeks prior to enrollment, with investigator-judged risk of major bleeding.
• •3. Chemotherapy, targeted therapy, or immunomodulatory agents (including thymosin, interferon, IL-2, etc.) within 2 weeks prior to enrollment.
• •Washout period determined by clinical resolution of adverse events (AEs) and prior treatment regimens.
• •4. Palliative radiotherapy to localized lesions within 4 weeks prior to enrollment, unless the lesion is non-target and other measurable target lesions exist.
• •5. Grade ≥3 irAEs during prior immunotherapy.
• •6. Prior treatment with HDAC inhibitors or anti-angiogenic agents.
• •7. Urine protein ≥2+ or 24-hour urinary protein ≥1 g.
• •8. Systolic BP \>140 mmHg or diastolic BP \>90 mmHg despite treatment.
• •9. Persistent toxicity from prior antitumor therapy (per NCI CTCAE v5.0) \>Grade 1, excluding: alopecia, Grade 2 fatigue, Grade 2 anemia, or asymptomatic lab abnormalities.
• •10. Symptomatic CNS metastases (e.g., edema, steroid requirement) or leptomeningeal disease.
• •11. Systemic immunosuppressive drugs (excluding topical/inhaled corticosteroids or physiological doses ≤10 mg/day prednisone equivalent) or corticosteroids for contrast allergy within 4 weeks prior to enrollment.
• •12. Active autoimmune diseases (e.g., interstitial pneumonia, colitis, thyroiditis) or history of severe autoimmune conditions requiring systemic therapy.
• •Exceptions: Vitiligo, childhood asthma (resolved without treatment), or mild asthma managed without bronchodilators.
• •13. Ongoing anti-tuberculosis therapy or treatment within 1 year prior to screening.
• •14. Conditions requiring long-term immunosuppressive therapy or systemic corticosteroids at immunosuppressive doses.
• •15. Severe Cardiac Disease or Significant Cardiac Symptoms.
• •16. Other Circumstances Deemed Unsuitable by the Investigator