The topoisomerase I inhibitor topotecan (TPT) is used in the therapy of different tumors including high-grade gliomas. We previously showed that TPT-induced apoptosis depends on p53 with p53 wild-type (wt) cells being more resistant because of p53-controlled degradation of topoisomerase I. Here, we show that p53-deficient (p53 Ϫ/Ϫ ) fibroblasts undergo excessive mitochondrial apoptosis featuring H2AX phosphorylation, Bcl-x L decline, cytochrome c release, caspase-9/-3/-2 activation, and cleavage of Bid. In wt and apaf-1 Ϫ/Ϫ cells, caspase-2 did not become activated and Bid was not cleaved. In addition, p53Ϫ/Ϫ cells cotreated with TPT and caspase-3 inhibitor showed neither caspase-2 activation nor Bid cleavage, implying that caspase-2 is processed downstream of the apoptosome by caspase-3. Although processing of caspase-9/-3 was similar in wt and p53 Ϫ/Ϫ cells, only p53 Ϫ/Ϫ cells displayed active caspase-3. This was due to the proteasomal degradation of X-chromosome-linked inhibitor of apoptosis (XIAP) and survivin that inhibits caspase-3 activity. Accordingly, TPT-induced apoptosis in wt cells was increased after XIAP/survivin knockdown. Silencing of Bid led to reduction of TPT-triggered apoptosis. Data obtained with mouse fibroblasts could be extended to human glioma cells. In U87MG (p53wt) cells cotreated with TPT and pifithrin-␣, or transfected with p53-siRNA, caspase-2 and Bid were significantly cleaved and XIAP/survivin was degraded. Furthermore, the knockdown of XIAP and survivin led to increased TPT-triggered apoptosis. Overall, the data show that p53-deficient/depleted cells are hypersensitive to TPT because they down-regulate XIAP and survivin, and thus amplify the intrinsic apoptotic pathway via caspase-3-mediated Bid cleavage. Therefore, in gliomas harboring wild-type p53, TPT-based therapy might be improved by targeted down-regulation of XIAP and survivin.Topotecan (TPT) is a camptothecin derivative that belongs to the class of topoisomerase I (topoI) inhibitors. It is used in the therapy of different types of cancer including pediatric high-grade gliomas. After the formation of a DNA single-strand break, topoI remains covalently bound to the 3Ј end of the DNA phosphodiester backbone forming the topoI-DNA-cleavable complex (Nitiss and Wang, 1996), which is a reversible intermediate catalyzing the cleavagereligation reaction of the enzyme (Porter and Champoux, 1989). TopoI inhibitors such as TPT stabilize this complex preventing the religation of topoI-mediated single-strand breaks (Hertzberg et al., 1989). The cytotoxicity of topoI inhibitors is limited to the S phase of the cell cycle and is triggered by a collision of the replication fork with the inhibitor-stabilized cleavable complex. This results in blockage of fork movement and finally the formation of toxic DNA double-strand breaks (DSBs) (Hsiang et al., 1989;Goldwasser et al., 1996). These DSBs induce a checkpoint response by activation of upstream kinases like ataxia telangiectasia-mutated (ATM), ataxia telangiectasia and Rad3-relate...