Background: Apatinib is a small tyrosine kinase inhibitor targeting the vascular endogenous growth receptor 2 (VEGFR-2) that shows potent antitumor activities in various advanced cancers via the inhibition of neo-angiogenesis. The effect of apatinib in recurrent or metastatic head and neck cancers has not been fully demonstrated. Methods: Patients with recurrent or metastatic head and neck cancers consecutively treated in our institute by apatinib from January 2015 to December 2020 were enrolled. Daily 250 mg or 500 mg apatinib was given with or without chemotherapy according to patients' tolerance. A part of the patients also received palliative radiotherapy. Disease response, treatment-related toxicities and patient survival were analyzed. Toxicity was assessed by CTCAE v4.0. Kaplan-Meier analysis was used to estimate patients' overall survival. The R software (version 3.6.3) were used for statistical analysis. Results: A total of 73 patients were enrolled in this study. There were 59 males and 14 females with the median age of 55 (range: 27-80) years. Most patients had a performance status of 0 (15/73, 20.5%) and 1 (51/73, 69.9%). There were 29 oral cavity cancers, 20 nasopharyngeal carcinomas, 8 salivary gland cancers, 7 nasal and paranasal sinus cancers and 9 other malignancies. Pathologically, 47 were squamous cell carcinoma, 18 were adenoid cystic carcinoma, and the rest 8 were adenocarcinoma, sarcoma and melanoma. The majority of patients were with metastatic diseases (57/74, 78.1%). Nine of the 73 (12.3%) received apatinib as first-line treatment, 22 (30.1%) as second-line and 42 (57.5%) as more than second-line treatments. Forty patients received S-1 or capecitabine chemotherapy, 2 received nab-paclitaxel and 1 received gemcitabine. Ten patients received palliative radiotherapy. The most frequent toxicities were anemia (37/73, 50.7%), leucopenia (27/73, 37.0%), thrombocytopenia (20/73, 27.4%), proteinuria (20/73, 27.4%), arterial hypertension (17/73, 23.3%), hand-foot syndrome (17/73, 23.3%). Hemorrhage occurred in 10 (13.7%) patients. No treatment-associated death was noted. The median follow-up was 29.9 months. Fifty-six patients had evaluable tumor response. Complete response occurred in 1 patients. Partial response was seen in 3 patients. Most patients had stable disease (29/56, 51.8%) or progressive disease (23/56, 41.1%). By the end of the last follow-up, 33 patients died of disease progression. The median overall survival was 29.6 months. Conclusions: Apatinib showed modest antitumor activities in recurrent or metastatic head and neck cancers. The side effects were manageable. The effect of apatinib in recurrent or metastatic head and neck cancers warrants further studies in larger-scale randomized studies.