RAC Primer, page-138

I have a question, hopefully Dr T can answer but I thought I'd ask here so any response can be seen by all:

We're aware that one of the advantages of bisantrene compared to various anthracyclines such as doxorubicin is the lower cardiotoxicity, this is something that limits how high of a dose of doxorubicin that doctors are comfortable with giving patients. Trying to balance treating the cancer with the potential for heart failure. In this area bisantrene doesn't present the same concern and can potentially be given to patients in doses that are much more likely to be effective, if I'm understanding things correctly.

My question relates to myelosuppression. I've been reading some of the AML studies that have been done with bisantrene, and it seems as though almost all chemo drugs unfortunately induce severe myelosuppression, including bisantrene. This is something that in many cases is also a limiting factor for how high of a dose that doctors are going to give a patient of a particular chemo drug.

Do we know to what extent myelosuppression limits the potential safe dose for bisantrene when used for chemotherapy? If so, how does this compare to doxorubicin and the like? My concern is that even with the clear advantage that bisantrene has in the area of cardiotoxicity, the similarly severe amounts of myelosuppression that is induced might still present a limiting factor to how high of a dose that doctors would be comfortable to give their patients.

I feel as though pillar 3 really revolves around bisantrene's safety at these high doses. I'm sure this is an area that Race Oncology have already carefully considered, in fact it may already have been asked and answered here but I've only been on the HC RAC forum for a few months.