I don't think Bisantrene should ever be used as a single agent.
If the mechanism of cardioprotection is indeed universal, then I think Bisantrene will be the RNA cardioprotective monopoly play on the market. 95% of the top 20 most essential drugs in the world are rated to some degree of cardiotoxicity by the FDA. Etoposide is the only drug that is not considered cardiotoxic by the FDA, but the list was generated before the Doan paper where Etoposide was shown to be cardiotoxic in vitro.
If anthracyclines and Doxorubicin are the pleiotropic DNA targeting agent, then Bisantrene is the pleiotropic RNA targeted agent.
For a fun analogy (whoever it was that hadn't seen The Matrix, you better be up to speed by now):
If Agent Smith is the cancer that the Machines (Doxorubicin) are trying to eradicate, then Neo is Bisantrene. The Machines target DNA to perform their function, which is usually very effective, but many humans get hurt in the process (cardiotoxicity). However, Neo operates outside the box, using RNA to perform his function. You need both the Machines and Neo to effectively destroy Agent Smith while making sure no more humans get hurt.
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I don't think Bisantrene should ever be used as a single agent....
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