Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. Prognosis and treatment options are stage-dependent. Typically, prognosis of patients with unresectable HCC is poor, particularly for patients with distant metastasis. Sorafenib has demonstrated an overall survival benefit and has become the new standard of care for advanced HCC. However, in metastatic HCC, long-term progression-free survival for five years with reduced doses of sorafenib is extremely rare. In clinical practice, certain patients are discontinuing the use of this drug due to its side-effects. We highlight the importance of prolonged sorafenib administration, even at reduced doses. We describe an unusual case of a 74-year-old patient with HCC metastatic to the vertebrae that responded to a reduced dose of sorafenib and has subsequently demonstrated no signs of disease progression since starting treatment almost five years ago. This suggests that certain patients with highly progressive HCC involving bone metastasis may achieve long-term survival by reduced doses of sorafenib.