ISSUE: Targeted combination therapies (TCTs) are becoming the standard of care in oncology as diseases are attacked through multiple inhibition mechanisms. TCTs pose a budget challenge to health systems, and payers subject them to rigorous value assessment and funding restrictions. The budget challenge is accompanied by an economic return challenge for companies developing TCTs. Currently, however, there is no consensus regarding the exact causes and consequences of these challenges. Payers see the pricing of TCTs as ‘unsustainable’ and apply strong financial control through managed-entry agreements. Companies developing TCTs refer to low willingness-to-pay and inadequate assessment methods in many countries, but economic incentives seem to be conflicting between ‘backbone’ and ‘add-on’ therapies. Clinicians emphasize that combination therapy is a ‘must’ in most cancers, and policy-level solutions are needed for sustainable funding. This session will consider these different viewpoints and explore opportunities for policy-level approaches that take into account the different contexts of health care systems. OVERVIEW: Prof. Garrison will provide an overview of the economic and legal factors which lead to the visible challenges, and will describe the importance of conflicting economic incentives. He will be followed by three panelists representing different viewpoints. From an oncologist’s perspective, Prof Blay maintains that it is the peculiarities of TCT development and clinical trial design that reduce the economic potential of combination therapy compared to its scientific potential. Dr Dankó, from a policy perspective, thinks the key problem is that payers struggle to design HTA frameworks and price re-negotiation mechanisms for TCTs. Adding the perspective of companies developing TCTs, Dr Lothgren believes that finding mechanisms to attribute value to constituent therapies is essential to align conflicting incentives. After Prof. Garrison has summarized the viewpoints and outlined possible policy directions the audience will be invited to share their views and comment on the perspectives of the panelists.