435 Background: HCC is the third commonest malignancy worldwide, with the highest incidence rates in patients over 75 years of age. Although sorafenib is used for patients with advanced HCC, there are concerns about the outcomes and tolerability in this age group. Methods: We conducted a retrospective study of 190 patients treated with sorafenib (177 with sorafenib alone, 17 patients with a combination of sorafenib and erlotinib/placebo within the SEARCH trial). Patient demographics and outcomes were recorded. Results: 190 patients were identified with a median age of 66 (26-87). 151 patients were <75 years old (yrs) and 39 patients were >75. 157 patients were male and 33 female. Underlying liver disease in the over 75 group were: non-alcoholic fatty liver disease (N=14, 35.9%), unknown aetiology (N=14, 35.9%), alcoholic liver disease (N=7, 17.9%), hepatitis C (N=2, 5.1%), hepatitis B (N=1, 2.56%,) and autoimmune hepatitis (N=1, 2.56%). 33 patients were Child-Pugh A status when starting sorafenib (A5=25, A6=8) and 6 patients were Child-Pugh B (B7=5, B8=1). There was no statistically significant difference in OS between patients over the age of 75 and younger (7.1m for >75 yrs and 10.4 <75 yrs p=0.360), or in PFS (4.2m vs. 6.8m [p=0.539]). There was also no increase in G3/4 toxicities between both groups of patients with comparable incidences of G3/4 diarrhoea (4.7% <75 vs. 2.6% ≤75 p=0.481), skin toxicity (6.6% vs. 5.1% p=0.537), fatigue (7.3% vs. 7.7% p =0.58) and deteriorating liver function (2.6% vs. 7.3% p = 0.25). There was no difference between the incidence of dose reductions or interruptions (34% vs. 35.9% p=0.5). Conclusions: Our study suggests that patients aged 75 or older appear to tolerate treatment with sorafenib well with comparable toxicities to those less than 75. We also found no significant differences in survival. With an aging population and increasing incidences of HCC, further prospective evidence is needed to identify safety and survival outcomes in this important group of patients.