Metastatic castration-resistant prostate cancer: the decisions you may face

Cancer page →Second-opinion finder →

5 treatment settings, 5 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Advanced, first line

First line, androgen receptor pathway inhibitor-naive

5 optionsCompare side by side →

Abiraterone or enzalutamide; add olaparib, talazoparib or niraparib for HRR-mutant, above all BRCA-mutant, disease (PROpel, TALAPRO-2, MAGNITUDE).

Guideline

NCCN Guidelines: Prostate Cancer

The options, in plain words

Abiraterone acetateApprovedSmall-molecule CYP17A1 inhibitor

Abiraterone is a pill that shuts down testosterone production everywhere, including inside the tumour. Discovered at the Institute of Cancer Research, now generic and used from the first metastatic diagnosis.

EnzalutamideApprovedSmall-molecule AR antagonist

Enzalutamide is a second-generation androgen-receptor blocker that stops the receptor binding testosterone, entering the nucleus and switching on genes. It is approved at every stage of advanced prostate cancer, from rising PSA after surgery to castration-resistant disease, and fatigue, falls and memory problems are its main drawbacks.

OlaparibApprovedSmall-molecule PARP inhibitor

Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.

TalazoparibApprovedSmall-molecule PARP inhibitor

Talazoparib is a PARP inhibitor that traps PARP on DNA about 100 times more strongly than olaparib, which is why it works at a 1 mg daily dose. It is approved for germline BRCA-mutant HER2-negative breast cancer and, with enzalutamide, for HRR-mutant castration-resistant prostate cancer; anaemia is its dominant side effect.

NiraparibApprovedSmall-molecule PARP inhibitor

Niraparib is a PARP inhibitor approved as maintenance for ovarian cancer regardless of BRCA status, and in prostate cancer with abiraterone.

The evidence behind it

PROpel Phase 3 NCT03732820 2022796 peopleevidence 89
Tests Abiraterone acetate, Olaparib
First-line mCRPC, all-comers: abiraterone + olaparib vs abiraterone + placebo
rPFS HR 0.66 (ITT); OS HR 0.81 (NS).
Radiographic progression-free survival (investigator), all comers (months): Olaparib + abiraterone 24.8 (n=399) vs Placebo + abiraterone 16.6 (n=397) · HR 0.66 · source
TALAPRO-2 Phase 3 NCT03395197 2023805 peopleevidence 89
Tests Enzalutamide, Talazoparib
First-line mCRPC: enzalutamide + talazoparib vs enzalutamide + placebo (all-comers and HRR-mutant cohorts)
rPFS HR 0.63 (ITT); OS HR 0.80 (ITT), 0.62 (HRR-mutant).
Radiographic progression-free survival, all comers (months): Placebo + enzalutamide 21.9 (n=403) · HR 0.63 · source
MAGNITUDE Phase 3 NCT03748641 2022423 peopleevidence 78
Tests Abiraterone acetate, Niraparib
First-line mCRPC: abiraterone + niraparib vs abiraterone + placebo, HRR-mutant and HRR-negative cohorts
BRCA cohort rPFS HR 0.53; HRR-negative futility.
Radiographic progression-free survival, BRCA1/2 subgroup (months): Niraparib + abiraterone 16.6 (n=113) vs Placebo + abiraterone 10.9 (n=112) · HR 0.53 · source

The main trade-offs on record

Abiraterone acetate all recorded rates →

Take on an empty stomach: food raises exposure up to tenfold and increases toxicity. Prednisone 5 mg covers mineralocorticoid excess.
Reduce to 250 mg daily in moderate impairment; avoid in severe.

Enzalutamide all recorded rates →

Seizure risk: caution with drugs that lower the seizure threshold.

Olaparib all recorded rates →

Side effect	Any grade	Grade 3+
Anaemia · OlympiA adjuvant, n=911	24%	9%
Neutropenia · OlympiA adjuvant, n=911	16%	5%
Leukopenia · OlympiA adjuvant, n=911	17%	3%
Fatigue · OlympiA adjuvant, n=911	42%	1.8%

Avoid grapefruit and Seville oranges.
200 mg twice daily for CrCl 31-50.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Talazoparib all recorded rates →

0.75 mg daily for CrCl 30-59; 0.5 mg for 15-29.

Niraparib all recorded rates →

Side effect	Any grade	Grade 3+
Thrombocytopenia · PRIMA	66%	38%
Anaemia · PRIMA	65%	31%
Neutropenia · PRIMA	-	17%
Nausea · PRIMA	62%	-

Not CYP-metabolised (carboxylesterases), so few pharmacokinetic interactions. Hypertension and tachycardia: monitor blood pressure weekly for 2 months.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision

Between Abiraterone acetate, Enzalutamide, Olaparib and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
How closely do I match the people in PROpel and TALAPRO-2, and does that change what the results mean for me?
Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
Which side effects of Olaparib or Niraparib are most likely for me, which are reversible, and which would make us stop?
Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Prostate Cancer), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (first line, androgen receptor pathway inhibitor-naive), which of the standard options do you recommend and why?
Why: Guideline options include: Abiraterone or enzalutamide; add olaparib, talazoparib or niraparib for HRR-mutant, above all BRCA-mutant, disease (PROpel, TALAPRO-2, MAGNITUDE).
Am I a candidate for Abiraterone acetate, Enzalutamide, Olaparib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of PROpel and TALAPRO-2 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

After an androgen receptor pathway inhibitor

5 optionsCompare side by side →

Docetaxel; olaparib or rucaparib for BRCA-mutant disease (PROfound); 177Lu-PSMA-617 for PSMA-positive disease before chemotherapy (PSMAfore); pembrolizumab for mismatch repair-deficient tumours.

Guideline

NCCN Guidelines: Prostate Cancer

The options, in plain words

DocetaxelApprovedCytotoxic chemotherapy (taxane)

The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.

OlaparibApprovedSmall-molecule PARP inhibitor

Olaparib was the first PARP inhibitor, and turned an inherited BRCA mutation from a risk factor into a drug target, including after surgery in breast cancer.

RucaparibApprovedSmall-molecule PARP inhibitor

A PARP inhibitor for BRCA-mutated ovarian and prostate cancer whose original maker went bankrupt; still available, with a narrowed label.

Lutetium-177 vipivotide tetraxetanApprovedRadioligand therapy (beta)

A radioactive drug that seeks out PSMA on prostate cancer cells; the best-selling radiopharmaceutical ever.

PembrolizumabApprovedMonoclonal antibody (anti-PD-1)

Pembrolizumab is a PD-1 blocking antibody approved in more than 40 settings, from melanoma and lung cancer to the first tumour-agnostic approval for mismatch-repair-deficient tumours in 2017, and before and after surgery in triple-negative breast cancer. A subcutaneous form arrived in 2025, and it is the backbone partner for ADCs and personalised neoantigen vaccines.

The evidence behind it

PROfound Phase 3 NCT02987543 2020387 peopleevidence 87
Tests Olaparib
mCRPC with HRR gene alterations after ARPI: olaparib vs enzalutamide/abiraterone switch
rPFS HR 0.34; OS HR 0.69 (cohort A).
Radiographic progression-free survival, cohort A (BRCA1/2, ATM) (months): Olaparib 7.4 (n=162) vs Enzalutamide or abiraterone 3.6 (n=83) · HR 0.34 · source
PSMAfore Phase 3 NCT04689828 2023469 peopleevidence 87
Tests Lutetium-177 vipivotide tetraxetan
PSMA+ mCRPC after one ARPI, taxane-naive: 177Lu-PSMA-617 vs ARPI switch
rPFS HR 0.41.
Radiographic progression-free survival (months): 177Lu-PSMA-617 12 (n=234) vs ARPI switch 5.6 (n=234) · HR 0.41 · source

The main trade-offs on record

Docetaxel all recorded rates →

Do not give if bilirubin above ULN, or AST/ALT above 1.5 x ULN with alkaline phosphatase above 2.5 x ULN (treatment-related deaths).

Olaparib all recorded rates →

Side effect	Any grade	Grade 3+
Anaemia · OlympiA adjuvant, n=911	24%	9%
Neutropenia · OlympiA adjuvant, n=911	16%	5%
Leukopenia · OlympiA adjuvant, n=911	17%	3%
Fatigue · OlympiA adjuvant, n=911	42%	1.8%

Avoid grapefruit and Seville oranges.
200 mg twice daily for CrCl 31-50.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Lutetium-177 vipivotide tetraxetan all recorded rates →

Side effect	Any grade	Grade 3+
Lymphocytes decreased · VISION	85%	47%
Haemoglobin decreased · VISION	64%	15%
Platelets decreased · VISION	-	9%
Fatigue · VISION	48%	-

Radiation safety counselling; hydrate and void often. No pharmacokinetic drug interactions; concurrent myelosuppressive therapy adds cytopenia risk.
Not studied below CrCl 50; renal irradiation is dose-limiting over multiple cycles.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Pembrolizumab all recorded rates →

Side effect	Any grade	Grade 3+
Hypothyroidism (immune-mediated) · Pooled monotherapy data, >2,800 patients	8%	-
Pneumonitis (immune-mediated) · Pooled monotherapy data, >2,800 patients	3.4%	-
Colitis (immune-mediated) · Pooled monotherapy data, >2,800 patients	1.7%	-
Hepatitis (immune-mediated) · Pooled monotherapy data, >2,800 patients	0.7%	-

No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision

Between Docetaxel, Olaparib, Rucaparib and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
How closely do I match the people in PROfound and PSMAfore, and does that change what the results mean for me?
Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
Which side effects of Olaparib or Lutetium-177 vipivotide tetraxetan are most likely for me, which are reversible, and which would make us stop?
Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Prostate Cancer), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (after an androgen receptor pathway inhibitor), which of the standard options do you recommend and why?
Why: Guideline options include: Docetaxel; olaparib or rucaparib for BRCA-mutant disease (PROfound); 177Lu-PSMA-617 for PSMA-positive disease before chemotherapy (PSMAfore); pembrolizumab for mismatch repair-deficient tumours.
Am I a candidate for Docetaxel, Olaparib, Rucaparib or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of PROfound and PSMAfore apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

After docetaxel

3 optionsCompare side by side →

177Lu-PSMA-617 (VISION), cabazitaxel, radium-223 for symptomatic bone-only disease (ALSYMPCA), or a PARP inhibitor if not yet used.

Guideline

NCCN Guidelines: Prostate Cancer

The options, in plain words

Lutetium-177 vipivotide tetraxetanApprovedRadioligand therapy (beta)

A radioactive drug that seeks out PSMA on prostate cancer cells; the best-selling radiopharmaceutical ever.

CabazitaxelApprovedCytotoxic chemotherapy (taxane)

A second taxane that works after docetaxel and beat a second hormone pill head-to-head (CARD).

Radium-223 dichlorideApprovedTargeted alpha therapy (bone-seeking)

Radium-223 was the first alpha-emitting drug ever approved (2013). It homes to bone like calcium and treats prostate cancer that has spread only to bone.

The evidence behind it

VISION Phase 3 NCT03511664 2021861 peopleevidence 95
Tests Lutetium-177 vipivotide tetraxetan
PSMA+ metastatic castration-resistant prostate cancer after ARPI and taxane: 177Lu-PSMA-617 + SOC vs SOC
OS HR 0.62.
Overall survival (months): 177Lu-PSMA-617 + standard care 15.3 (n=551) vs Standard care 11.3 (n=280) · HR 0.62 · source
ALSYMPCA Phase 3 NCT00699751 2013921 peopleevidence 85
Tests Radium-223 dichloride
Symptomatic bone-metastatic CRPC without visceral disease: radium-223 vs placebo
OS HR 0.70.
Overall survival (months): Radium-223 14.9 (n=614) vs Placebo 11.3 (n=307) · HR 0.7 · source
TheraP (ANZUP 1603)Phase 2 NCT03392428 2021201 peopleevidence 65
Tests Lutetium-177 vipivotide tetraxetan, Cabazitaxel
mCRPC after docetaxel: 177Lu-PSMA-617 vs cabazitaxel, PSMA PET/FDG PET selected
PSA50 66% vs 37%; OS HR 0.97.
PSA response ≥50% (%): 177Lu-PSMA-617 66 (n=99) vs Cabazitaxel 37 (n=101) · source

The main trade-offs on record

Lutetium-177 vipivotide tetraxetan all recorded rates →

Side effect	Any grade	Grade 3+
Lymphocytes decreased · VISION	85%	47%
Haemoglobin decreased · VISION	64%	15%
Platelets decreased · VISION	-	9%
Fatigue · VISION	48%	-

Radiation safety counselling; hydrate and void often. No pharmacokinetic drug interactions; concurrent myelosuppressive therapy adds cytopenia risk.
Not studied below CrCl 50; renal irradiation is dose-limiting over multiple cycles.

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision

Between Lutetium-177 vipivotide tetraxetan, Cabazitaxel and Radium-223 dichloride, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
How closely do I match the people in VISION and ALSYMPCA, and does that change what the results mean for me?
Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
Which side effects of Lutetium-177 vipivotide tetraxetan are most likely for me, which are reversible, and which would make us stop?
Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Prostate Cancer), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (after docetaxel), which of the standard options do you recommend and why?
Why: Guideline options include: 177Lu-PSMA-617 (VISION), cabazitaxel, radium-223 for symptomatic bone-only disease (ALSYMPCA), or a PARP inhibitor if not yet used.
Am I a candidate for Lutetium-177 vipivotide tetraxetan, Cabazitaxel, Radium-223 dichloride, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of VISION and ALSYMPCA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Bone health

3 optionsCompare side by side →

Denosumab or zoledronic acid to prevent skeletal events, with calcium and vitamin D; palliative radiotherapy to painful metastases.

Guideline

NCCN Guidelines: Prostate Cancer

The options, in plain words

DenosumabApprovedMonoclonal antibody (anti-RANKL, fully human IgG2)

Denosumab is an injection under the skin that blocks the signal driving bone breakdown. As Xgeva it prevents fractures and other bone complications in people whose cancer has spread to bone or who have myeloma; as Prolia it treats osteoporosis, including bone loss caused by hormone therapy for breast and prostate cancer.

Zoledronic acidApprovedNitrogen-containing bisphosphonate (intravenous)

Zoledronic acid (Zometa) is a fifteen-minute infusion given every few weeks or months to strengthen bone and prevent fractures, spinal cord compression and the need for radiotherapy in people with myeloma or cancer that has spread to bone; it also treats dangerously high calcium caused by cancer.

SBRT / SABR (stereotactic radiotherapy)Standard of care

Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.

Ablative doses with minimal recovery
Outpatient

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

SBRT / SABR (stereotactic radiotherapy)

Size and location limits
Late toxicity near central airways

Questions to ask about this decision

Between Denosumab, Zoledronic acid and SBRT / SABR (stereotactic radiotherapy), which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Prostate Cancer), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (bone health), which of the standard options do you recommend and why?
Why: Guideline options include: Denosumab or zoledronic acid to prevent skeletal events, with calcium and vitamin D; palliative radiotherapy to painful metastases.
Am I a candidate for Denosumab, Zoledronic acid, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Phase 3 options

4 optionsCompare side by side →

Actinium-225 PSMA radioligands, the STEAP1 T-cell engager xaluritamig, the EZH2 inhibitor mevrometostat and 177Lu-PSMA-I&T within trials.

The options, in plain words

Actinium-225 PSMA agentsPhase 3Targeted alpha therapy

Alpha-emitting PSMA drugs that produce responses even after Pluvicto fails, held back mainly by isotope supply.

XaluritamigPhase 3Bispecific T-cell engager (STEAP1×CD3, XmAb 2+1)

Xaluritamig is Amgen's T-cell engager for prostate cancer, now in two phase 3 trials, aiming to do for prostate cancer what tarlatamab did for small-cell lung cancer.

MevrometostatPhase 3Small-molecule EZH2 inhibitor

An epigenetic drug that may re-sensitise prostate cancer to hormone therapy, in three phase 3 trials with enzalutamide.

177Lu-PSMA-I&TPhase 3Radioligand therapy (beta)

177Lu-PSMA-I&T is a second PSMA radioligand, chemically different from Pluvicto, that has passed two phase 3 trials on progression but has not yet shown a survival benefit.

The evidence behind it

AlphaBreak (FPI-2265) & AcTION (225Ac-PSMA-617)Phase 2 NCT06402331600 peopleevidence 29
Tests Actinium-225 PSMA agents
PSMA-positive mCRPC: actinium-225 PSMA radioligands vs standard of care, including after 177Lu-PSMA
No headline result recorded yet.
XALute Phase 3 NCT06691984707 peopleevidence 49
Tests Xaluritamig
mCRPC after ARPI and taxane: xaluritamig vs cabazitaxel or second ARPI (investigator's choice; ≥50% cabazitaxel)
No headline result recorded yet.
MEVPRO-1 Phase 3 NCT06551324600 peopleevidence 49
Tests Mevrometostat
mCRPC after abiraterone: mevrometostat + enzalutamide vs physician's choice (enzalutamide or docetaxel)
No headline result recorded yet.
SPLASH Phase 3 NCT04647526 2024455 peopleevidence 73
Tests 177Lu-PSMA-I&T
PSMA-positive mCRPC after one ARPI, taxane-naive: 177Lu-PNT2002 vs ARPI switch
rPFS HR 0.71; interim OS HR 1.11.
Radiographic progression-free survival (months): 177Lu-PNT2002 (PSMA-I&T) 9.5 (n=276) vs ARPI switch 6 (n=136) · HR 0.71 · source
ECLIPSE Phase 3 NCT05204927 2025439 peopleevidence 82
Tests 177Lu-PSMA-I&T
PSMA-positive mCRPC after ARPI, taxane-naive: 177Lu-PSMA-I&T (7.4 GBq × 6) vs ARPI switch
rPFS significantly improved.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision

Between Actinium-225 PSMA agents, Xaluritamig, Mevrometostat and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
How closely do I match the people in AlphaBreak (FPI-2265) & AcTION (225Ac-PSMA-617) and XALute, and does that change what the results mean for me?
Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (phase 3 options), which of the standard options do you recommend and why?
Why: Guideline options include: Actinium-225 PSMA radioligands, the STEAP1 T-cell engager xaluritamig, the EZH2 inhibitor mevrometostat and 177Lu-PSMA-I&T within trials.
Am I a candidate for Actinium-225 PSMA agents, Xaluritamig, Mevrometostat or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of AlphaBreak (FPI-2265) & AcTION (225Ac-PSMA-617) and XALute apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.