OBJECTIVES: To explore the relationship between lines of therapy and submission for reimbursement across disease conditions and types of therapy. METHODS: This study looked at 252 Health Technology Assessments from eight agencies: CADTH, CCO, HAS, HIS, NICE, PBAC, SMC, and pCODR. The data covered 41 drugs across seven solid-state tumor cancer conditions.  RESULTS: Of the 41 drugs, 27% (11/41) were initially submitted for first-line therapy and 73% (8/11) were recommended for reimbursement. Similarly, 32% (13/41) were initially submitted for second-line therapy and 77% (10/13) were recommended for reimbursement. Cytotoxic drugs were most likely to be reviewed initially for first-line therapy at 35% (7/20) and second-line therapy at 25% (5/20); targeted therapies were most likely to be reviewed initially for second-line therapy at 38% (8/21) and adjuvant therapy at 24% (5/21).  The percentage of drugs reviewed for two or more lines of therapy varied greatly across conditions. Colorectal Cancer, SCLC, and NSCLC had the greatest percentages of drugs reviewed for 2+ lines of therapy with 100% (4/4), 100% (1/1), and 83% (5/6), respectively. Melanoma, Prostate Cancer, and Ovarian had the lowest percentages with 0% (0/2), 14% (1/7), and 40% (2/5), respectively. Additionally, there was a positive correlation (r= 0.9) between the number of drugs reviewed and number of lines of therapy covered per disease condition. CONCLUSIONS: There was no discernable difference in the rate of reimbursement between drugs initially submitted for first-line therapy or second-line therapy. There were, however, differences in various trends across disease conditions and between types of therapy. Future research will focus on trends across agencies and will include a larger sample size covering more conditions as well as investigational case studies on frequently reviewed drugs.