Lenvatinib

The patients were divided into four groups, including the camrelizumab monotherapy group (C group, n = 97), camrelizumab plus apatinib group (C+A group, n = 125), camrelizumab plus lenvatinib group (C+L group, n = 120), and camrelizumab plus sorafenib group (C+S group, n = 114).
1) The patients in the C group received intravenous camrelizumab 200 mg every 3 weeks (Jiangsu Hengrui Pharmaceuticals Co., Ltd., Jiangsu, China).
2) The patients in the C+A group received intravenous camrelizumab 200 mg every 3 weeks plus oral apatinib 850 mg daily (Jiangsu Hengrui Pharmaceuticals Co., Ltd., Jiangsu, China).
3) The patients in the C+L group received the intravenous camrelizumab 200 mg every 3 weeks plus oral lenvatinib 12 mg daily (for bodyweight ≥60 kg)/lenvatinib 8 mg daily (for bodyweight <60 kg).
4) The patients in the C+S group received the intravenous camrelizumab 200 mg every 3 weeks plus oral sorafenib 400 mg bi-daily (Bayer Pharma AG, Leverkusen, Germany).
Patients received immunotherapy for at least 2 cycles and targeted therapy for at least 42 days. All patients were routinely checked for blood routine, liver and kidney function, electrolytes, coagulation function, thyroid function, myocardial enzyme profile, electrocardiogram, and cardiac ultrasound before each cycle of treatment, and chest and abdomen enhanced CT was performed every two cycles to evaluate the efficacy.

All patients in group A received sequential systemic therapy with molecular targeted agents after the TIPS procedure when the symptoms of portal hypertension were controlled. Patients received a daily oral dose of sorafenib (400 mg/bid, Bayer) or lenvatinib (8–12 mg/qd, Eisai Co Ltd). Patients received regorafenib (120–160 mg/qd during weeks 1–3 of each 4-week cycle, Bayer) if they were nonresponders or tolerated sorafenib or lenvatinib. The treatment strategy is shown in Fig. 3.
Fig. 3

Treatment strategy for advanced hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT)–related symptomatic portal hypertension to improve survival. A transjugular intrahepatic portosystemic shunt (TIPS) is used to resolve portal hypertension complications, including variceal bleeding, refractory ascites or hydrothorax, and access to antitumour treatment opportunities (molecular targeted agents)