I agree. My gut feel is that the way they are modifying the anthracycline to reduce cardiotoxicity also reduces the anti-cancer effect. It simply taking away the cytotoxic effects and thus reducing cardiotoxicity.
The ROS production aids the anti-cancer effect and thus preventing this reduces efficacy. Bisantrene has a magic wand that has (i) low cardiotoxicity (ii) protects against cardiotoxicity of other anthracyclines, and (iii) increases anti-cancer effect by way of synergy.
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