A retrospective cohort study of 140 patients with advanced or recurrent cervical cancer analyzed factors associated with early resistance to PD-1 inhibitors after at least two cycles of treatment. Resistance developed in 68 patients (48.6%). Patients with resistance had a significantly higher baseline neutrophil-to-lymphocyte ratio (NLR: 4.09 ± 1.64 vs. 3.02 ± 1.28, p < 0.001) and a higher lactate dehydrogenase level (LDH: 264.4 ± 88.9 U/L vs. 216.8 ± 69.4 U/L, p = 0.003). Resistant patients were more often treated previously with chemotherapy (47.2%, p = 0.018). In multivariable analysis, NLR (OR = 1.62, 95% CI 1.21–2.17, p = 0.002) and LDH (OR = 1.05 per 10 U/L increase, 95% CI 1.01–1.09, p = 0.012) were independent predictors of resistance. The combined model with NLR, LDH, PD-L1 and prior chemotherapy achieved an AUC of 0.842 (95% CI 0.773–0.911). An exploratory analysis showed a disease control rate of 72.2% with PD-1 combination regimens in previously resistant patients.