I should probably add why better anthracyclines are of no...

I should probably add why better anthracyclines are of no interest to clinicians - clinical familiarity. Doctors (like most people) like to keep using a product they know and understand even if it is inferior to some new and better alternative. Annamycin would have to be very significantly better than doxorubicin to induce change. As an anticancer drug doxorubicin is very, very effective so this is a massive barrier to clear - just being as good as doxorubicin without cardiotoxicity is not enough.

The other factor is many oncologists are not as concerned about cardiotoxicity as they really should be. This is why all the other drugs that just provide cardioprotection are rarely used - to effect real change you need to have both increased anticancer activity and cardioprotection. This requirement was explored in depth in the primary market research Triangle undertook in 2023. They spoke to a lot of doctors (and insurance companies) about what bisantrene would have to deliver to cause change in treatment practice.