Annamycin faces the same issue bisantrene does as an alternative to doxorubicin - doctors won’t switch to using it even if it is less cardiotoxicity. The difficulty is any alternative to doxorubicin (daunorubicin in the case of AML) needs to be significantly more effective and doxorubicin is probably as good as you can make an anthracycline-like drug. The more I study doxorubicin the more impressed I am with it - there is a very good reason it is so widely used.
The second major issue with Annamycin is in AML there is (thanks to venetoclax) a move away from high intensity therapy which most patients can’t tolerate. In a few years time almost no AML patients are going to receive high intensity therapy. This would leave Annamycin with no market.
Cardioprotection thread, page-623
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