Nasopharyngeal Carcinoma (NPC) is an Epstein-Barr Virus (EBV)-associated malignant tumor with high recurrence/metastasis rates. Immunotherapy, including EBV-directed vaccines, adoptive cell therapy (ACT), and immune checkpoint inhibitors (ICIs), has become a core treatment. ICIs, especially PD-1 inhibitors, have achieved significant efficacy in advanced and locally advanced NPC, forming multi-line combination regimens. However, challenges such as low monotherapy response rates, immune resistance, and lack of reliable biomarkers remain. This review summarizes the latest progress and discusses future directions for precision immunotherapy.