This discussion paper analyses data from NHS London and NHS North West, which found that around 10% of Cancer Drugs Fund approvals were for off-label treatments. This represents an improvement of between 39% and 51% since RCF's last analysis in 2009. It makes recommendations for how recent policy developments could be capitalised on to position England as a leader in research into off-label prescribing, through ensuring enrolment in clinical trials and effective data collection on those patients who access drugs through the Cancer Drugs Fund.