Several types of cytoproliferative diseases, including cancers and autoimmune diseases, are associated with elevated cellular levels of pyrimidine nucleotides. This review assembles literature evidence supporting a thesis that elevated pyrimidine levels drive cytoproliferation largely through DNA-synthesis-independent mechanisms, which circumstance, it is proposed, inherently limits clinical efficacy of DNA-synthesis-targeting cytostatic drugs. Five hypothetical mechanisms, with supporting literature evidence, are presented: (1) Pyrimidine nucleotides released from ion channels auto/paracrinally and persistently activate the EGFR, PKC and ERK signaling pathway, upregulating cytokines and Cdk2; (2) One effect of ERK activation is reversal of allosteric control of de novo pyrimidine biosynthesis; thus pyrimidines' auto/paracrine ERK activation may reflect positive autoregulation; (3) Elevated intracellular pyrimidine nucleotides preferentially upregulate tumorigenic genes; (4) Elevated pyrimidines promote aberrant glycosylation of transcription factors; and (5) These diverse pyrimidine effects contribute, by different paths yet collectively, to repression of p53 or of its function. Also reviewed are alternate pyrimidine biosynthesis pathways relevant to disease. Based on these hypotheses, a clinical strategy for cytoproliferative disease is proposed that co-targets three cellular processes seen as "linchpins" of pyrimidines' auto/paracrine effects, including targeting alternate pyrimidine biosynthesis pathways.