This report, sponsored by Janssen, examines the challenges faced by health insurers, payers, and Health Technology Assessment (HTA) agencies in Europe when assessing new cancer therapies. It focuses on eight European countries and the approval process for twelve new cancer treatments. The report includes insights from desk research, a literature review, and interviews with academics, HTA experts, and other stakeholders. The report highlights the difficulties in assessing new cancer therapies and the need for HTA to adapt to changing times. It also discusses the importance of balancing sustainability with access in the future of HTA. The report provides a comprehensive overview of the current state of HTA in Europe and offers recommendations for how it can be improved to better evaluate novel cancer therapies.