Europe is experiencing a ‘value crisis’ for cancer medicines. Whilst some therapeutic innovations have delivered substantial clinically meaningful benefits, many new cancer drugs benefits are marginal. At the same time prices (and overall costs) have dramatically increased. The reasons behind this are multifactorial. Multi-level intervention including changing the narrative of patient organisations, altering the clinical communities acceptance of poor quality clinical trials, integrating socio-economic studies, requiring a balanced portfolio approach from public funders, raising the regulatory requisites and embedding health technology assessment will all be needed to ensure valuable, sustainable and equitable cancer medicines.