The gemcitabine plus cisplatin regimen is the standard-of-care first-line treatment for patients with metastatic or recurrent NPC unsuitable for local treatment.4 The addition of a programmed cell death protein-1 (PD-1) inhibitor further improved the efficacy, with a median progression-free survival (PFS) of 9.6-11.7 months (an updated figure is 21.4),5-8 and has become a new first-line recommended regimen. This evidence concerns the gene PDCD1 and nasopharyngeal carcinoma.