Originally identified as an innate cytotoxin, nitric oxide (•NO) formation in tumors can influence chemotherapy and exacerbate cancer progression. Here, we examined the hypothesis that •NO generation contributes to cancer cell drug resistance towards the widely used anticancer drug Etoposide (VP-16). The UV-V is spectrum of VP-16 was not changed by exposure of VP-16 to •NO in aqueous buffer. In contrast, reddish-orange compound(s) characteristic of o-quinone- and nitroso-VP-16, were readily generated in a hydrophobic medium (chloroform) in an oxygen-dependent manner. Similar products were also formed when the VP-16 radical, generated from VP-16 and horseradish peroxidase/H2O2, was exposed directly to •NO in chloroform in the presence of oxygen. Separation and spectral analysis of VP-16 reaction extracts by electron spin resonance and UV-Vis indicated generation of the phenoxy radical and the o-quinone of VP-16, as well as putative nitroxide, iminoxyl and other nitrogen oxide intermediates. Nitric oxide products of VP-16 displayed significantly diminished topoisomerase II-dependent cleavage of DNA and cytotoxicity to human HL-60 leukemia cells. LPS-mediated induction of nitric oxide synthase in murine macrophages resulted in VP-16 resistance compared to Raw cells. Furthermore, •NO products derived from iNOS rapidly reacted with VP-16 leading to decreased DNA damage and cytotoxicity. Together, these observations suggest that formation of •NO in tumors (associated macrophages) can contribute to VP-16 resistance via detoxification of VP-16.