This is a very good question. Liposomal doxorubicin (Doxil) has reduced toxicity compared to doxorubicin, but it is far from free of cardiotoxicity. It also comes with a really nasty side effect called hand-foot syndrome (chemotherapy-induced acral erythema) for which the only treatment is stopping the use of Doxil [1].
As for why bisantrene is better than doxorubicin in regards cardiotoxicity that is unknown. Lederle found bisantrene through an extensive search for an anthracycline similar doxorubicin in action, but one that didn’t show cardiotoxicity. It would be worth exploring scientifically why bisantrene has this property, but it is not necessary to take it back into the clinic - the FDA (and doctors) cares about how the drug behaves, not the underlying molecular reason why.
1. https://en.wikipedia.org/wiki/Chemotherapy-induced_acral_erythema
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