Intrinsic or acquired chemoresistance to alkylating agents is a major cause of treatment failure in patients with malignant brain tumors. Alkylating agents, the mainstay of treatment for brain tumors, damage the DNA and induce apoptosis, but the cytotoxic activity of these agents is dependent on DNA repair pathways. For example, O 6 -methylguanine DNA adducts can cause double-strand breaks, but this is dependent on a functional mismatch repair pathway. Thus, tumor cell lines deficient in mismatch repair are resistant to alkylating agents. Perhaps the most important mechanism of resistance to alkylating agents is the DNA repair enzyme O 6 -methylguanine methyltransferase, which can eliminate the cytotoxic O 6 -methylguanine DNA adduct before it causes harm. Another mechanism of resistance to alkylating agents is the base excision repair (BER) pathway. Consequently, efforts are ongoing to develop effective inhibitors of BER. Poly(ADP-ribose)polymerase plays a pivotal role in BER and is an important therapeutic target. Developing effective strategies to overcome chemoresistance requires the identification of reliable preclinical models that recapitulate human disease and which can be used to facilitate drug development. This article describes the diverse mechanisms of chemoresistance operating in malignant glioma and efforts to develop reliable preclinical models and novel pharmacologic approaches to overcome resistance to alkylating agents.Intrinsic or acquired resistance to cytotoxic agents remains the greatest obstacle to the successful treatment of human cancer, and a variety of mechanisms of drug resistance have been identified in human tumors. High-grade malignant gliomas, including glioblastoma and anaplastic astrocytoma, are among the most rapidly growing and devastating cancers. Standard treatment consists of surgery followed by radiotherapy and chemotherapy with alkylating agents. Alkylating agents, including carmustine (bischloroethyl nitrosourea, or BCNU), lomustine (chloroethylnitrosourea), and temozolomide, readily cross the blood-brain barrier and have shown the most activity against malignant glioma. However, despite the ability of these agents to achieve therapeutic concentrations in the brain, malignant gliomas are often resistant to alkylating agents. Identifying and understanding the diverse mechanisms of chemoresistance operating in human tumors and developing effective strategies to overcome resistance is the focus of ongoing preclinical and clinical research.One important mechanism of resistance to alkylating agents is mediated by the DNA repair enzyme O 6 -methylguanine methyltransferase (MGMT; refs. 1, 2), which repairs O 6 -alkylguanine adducts. BCNU and chloroethylnitrosourea are bifunctional alkylating agents that form lethal double-strand cross-links (3). In contrast, the activity of methylating agents such as temozolomide and dacarbazine results in persistent O 6 -methylguanine adducts that initiate futile cycling of the DNA mismatch repair (MMR) pathway, which ultimately caus...