This article will provide an overview of the evolving nature of cancer treatment, the benefits and challenges of these new treatments, and the leadership strategies required to manage the evolution from a system perspective. The number and complexity of novel cancer therapies, while offering improved patient outcomes, has become a challenge for the healthcare system due to the high cost of these new therapies. In Canada, the implementation of the pan-Canadian Oncology Drug Review and the pan-Canadian Pharmaceutical Alliance helps to streamline the review and negotiating process and to ensure consistency across provinces. Strategies to support these processes include ensuring safe patient treatment, patient counselling, clinician education, and practice innovation.