OBJECTIVES To provide a better understanding of: how changes in the use of an oncology medicine can affect its aggregate value; how different HTA systems have assessed these value expansions; and whether there is a link between value expansions and use. METHODS We examine all oncology medicines approved by the EMA between 2003 and 2005 – giving a sample of 10 medicines. Our framework sets out seven possible value expansions beyond an initial approved indication: different cancer type; different disease stage; different treatment line/stage; different treatment regimen; orphan designation; patient sub-population; and new route of administration. We then assessed how HAS (France), NICE (England and Wales), and Aetna (US) have recognised these value expansions. Finally, we analysed IMS data (2004-2013) on prices, volumes and sales for the five of the medicines. RESULTS Seven of the 10 medicines in the sample have additional value expansions following initial indication. Many are now used for indications that are very different from their original indication. Most of the HAS assessments resulted in the drug being reimbursed but the rewards to the manufacturers were in many cases relatively low because few of the recommended drugs were given low “improvement in medical service” (ASMR) levels. The majority of NICE appraisals (63%) resulted in the drug/indication not being recommended for use in the NHS. Generally, the UK had lower prices, volumes and sales than France and the US (with some exceptions). The comparisons between France and the US were a little more equivocal. There is a mixed picture in terms of the correlation between NICE/HAS recommendations and sales in the UK/France. We observe a link between expansions in licensed indications and changes in sales. CONCLUSIONS Health systems and policy makers need to recognise how product life-cycle considerations affect the value of medicines, and in particular, oncology medicines.