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A multicenter randomized controlled trial established sorafenib as a standard of care for patients with advanced hepatocellular carcinoma (HCC). Because the study was prematurely interrupted due to survival benefits in the sorafenib arm, we conducted an observational study to adequately assess risks and benefits of this regimen in field practice. Starting in 2008, all clinically compensated patients with advanced HCC and those with an intermediate HCC who were unfit or failed to respond to ablative therapies were consecutively evaluated in six liver centers in Italy, for tolerability as well as radiologic and survival response to 800‐mg/d sorafenib therapy. Treatment was down‐dosed or interrupted according to drug label. Two hundred ninety‐six patients (88% Child‐Pugh A, 75% Barcelona Clinic Liver Cancer [BCLC]‐C, and 25% BCLC‐B) received sorafenib for 3.8 months (95% CI 3.3‐4.4). Two hundred sixty …