S23906-1 is a benzo [b]acronycine derivative acting as a DNAalkylating agent through covalent bonding to the exocyclic amino group of guanines and subsequent local opening of the DNA helix. This compound was selected for phase I clinical trials based on its efficient antitumor activity in experimental models and its unique mode of action. S23906-1 is the racemate of cis-1, 2-diacetoxy-6-methoxy-3,3,14-trimethyl-1,2,3,14-tetrahydro-7H-benzo[b]pyrano[3,2-h]acridin-7-one. Here, we evaluated the cytotoxic and antitumor activities of the two pure cisenantiomers and investigated the mechanism of action of both cis-and trans-racemates and their enantiomers in terms of DNA alkylation potency and locally drug-induced DNA helix opening process. Reaction with glutathione, as a detoxification process, was also studied. The trans-compounds, both as racemate or separated enantiomers, were found less potent than the corresponding cis-derivatives. Among the cis-enantiomers, the most efficient one regarding DNA alkylation bears the acetate on the reactive C1 position in the R configuration, both on purified DNA and genomic DNA extracted from cell cultures. By contrast, the most cytotoxic and tumor-active enantiomer bears the C1-acetate in the S configuration. Distinct cellular DNA-alkylation levels or covalent bonding to glutathione could not explain the differences. However, we showed that the S and R orientations of the acetate on C1 asymmetric carbon lead to different local opening of the DNA, as visualized using nuclease S1 mapping. These different interactions could lead to modulated DNA-repair, protein/DNA interaction, and apoptosis processes.The stereoisomeric position of functional groups in bioactive molecules has been known for more than 100 years to exert an impact on the reactivity of biologically relevant compounds, including drugs. The presence of an asymmetric center in a drug requires specific studies to assess the potency of each isomer. Several cases can be encountered. 1) Both enantiomers display similar activities (qualitative and quantitative), fully justifying the clinical use of a racemate, exemplified by flecainide and fluoxetine (antiarrhythmic and antidepressant drugs, respectively) (Kroemer et al., 1989;Magyar et al., 2003). 2) The enantiomers have similar pharmacological effects but different concentration-response efficiencies, such as S-(Ϫ)-warfarin 3-to 5-fold more potent as an