Though the selection and administration of cytotoxic drugs is usually restricted to specialist units, all doctors should be aware of both the available treatment and its associated problems. This review concerns new cytotoxic drugs and some new applications of current drugs. It is largely confined to drugs marketed in the United Kingdom in the past five years and drugs from abroad that are currently used in the United Kingdom, although some mention is made of those still undergoing clinical trial which may be more widely used in the future. Many new drugs are analogues: they are the product of a search for a compound related to an existing cytotoxic drug that will retain or surpass its efficacy with a simultaneous reduction in toxicity. Current drugs and their analogues ALKYLATING AGENTS Alkylating agents-for instance, busulphan, cyclophospha-mide, melphalan, and mustine-prevent replication of nucleic acids by cross linking base pairs. Doses of all alkylating agents are limited by myelosuppression and gastrointestinal disturbance; haemorrhagic cystitis is dose limiting for cyclophosphamide. ANALOGUES OF ALKYLATING AGENTS Ifosfamide (Mitoxana) is structurally related to cyclophos-phamide. It may have better activity against non-small cell lung cancer and soft tissue sarcoma, but otherwise there is no convincing evidence of superiority over cyclophosphamide. Gastrointestinal side effects and haemorrhagic cystitis seem to be more severe than after cyclophosphamide but this may be related to differences in dose rather than in biological activity. Disturbances of consciousness have been reported after ifosfamide. Treosulfan (Treosulfan Leo) is a derivative of busulphan used to treat ovarian cancer. Like busulphan it is myelo-suppressive and causes skin pigmentation. NEW DEVELOPMENTS WITH ALKYLATING AGENTS The oxazophosphorenes (cyclophosphamide and ifosfamide) cause haemorrhagic cystitis because an inactive metabolite,