Purine and pyrimidine analogues remain an important class of drugs in the treatment of cancer. Although these agents share many structural and biochemical characteristics, each compound has unique activities that make it a useful drug. The basis of selectivity of these agents is not clearly denned (because the molecular targets exist in both tumor cells and normal host tissues) but is believed to be primarily due to differences in metabolism and proliferative states between tumor cells and normal cells. For instance, the greater expression of deoxycytidine kinase in leukemias and lym-phomas is believed to contribute to the sensitivity of these malignancies to nucleoside analogues that are activated by this enzyme. Furthermore, most normal cells in a patient are quiescent and, therefore, are not sensitive to these agents. However, the selectivity of antimetabolites is still poor and better agents are needed with fewer toxicities. Analysis of the existing agents identifies three primary characteristics of antimetabolites that are important to their ability to kill tumor cells: sufficient metabolism to active metabolite; long retention of active metabolite; and potent and sustained inhibition of DNA replication or function. The analogue should be a reasonable substrate for the activating enzymes, although clearly this aspect of the activity of an analogue can be affected by the potency of the active metabolite against the enzymatic target. For instance, an analogue that produces a very potent active metabolite would not be as dependent on activation. In addition to all the anabolic enzymes involved in the activation of nucleoside analogues, there are numerous catabolic enzymes that interact with these compounds, and these enzymes can also have profound impact on their biological activity and are important in the activity of all of the purine and pyrimidine antimetabolites. The compound should be a good selective inhibitor of DNA replication and have minimal effects on RNA and protein synthesis, as inhibition of these activities leads to toxicity. The primary intracellular targets of the existing purine and pyrimidine antimetabolites are DNA polymerases, thymidylate synthetase, and ribonucleotide reductase. Although some of the currently approved agents (FUra, mercaptopurine, thioguanine, and aza-Cyd) are converted to ribonucleotide metabolites and are extensively incorporated into RNA, the primary activity of these compounds that results in their antitumor activity is their inhibition of DNA synthesis or disruption of DNA function. Unless there is selective activation in tumor cells, nucleoside analogues that target RNA synthesis or function should be extremely cytotoxic, since all cells require RNA for vitality. As with most other classical antitumor agents, the inhibition of DNA replication is the most important action of purine and pyrimidine metabolites responsible for their antitumor activity. Disruption of de novo purine biosynthesis or RNA effects are secondary to activities that disrupt DNA replication or cause DNA damage. However, inhibition of DNA synthesis is not sufficient to kill a tumor cell. For example, an agent such as aphidicolin, which is a potent inhibitor of DNA replication, is a good cell synchronizer, because it only inhibits DNA synthesis and, unlike nucleoside analogues, it does not cause any lasting inhibition. Once it is removed from the cell, DNA synthesis readily resumes without lasting toxicity. Nucleoside analogues have two attributes that result in a lasting inhibition of DNA replication after removal of the drug by natural processes within the body. First, the active metabolites of these agents are nucleotide analogues, which do not readily penetrate cell membranes and, therefore, are retained in the cell after the drug has been removed, which is an attribute that is unique to this class of antitumor agents. The half-life for the removal of the triphosphates from cells can be quite long, which leads to continued use by the polymerases and, thus, continued inhibition of DNA replication. The intracellular retention time of the active metabolites (nucleoside triphosphate) can vary considerably between the various analogues, and this can have an important effect on the activity of an agent against solid tumor cells. The much longer half-life of dFdC-TP than araCTP is believed to be a primary contributing factor to the solid tumor activity of gemcitabine and the lack of solid tumor activity of araC. Second, nucleosides are incorporated into DNA, resulting in a DNA molecule that is not easily extended and must be repaired before synthesis can resume. Therefore, an agent that causes DNA damage that is poorly or slowly repaired will result in prolonged damage to the DNA, which will lead to the induction of apoptosis. In conclusion, purine and pyrimidine antimetabolites are an important class of drugs used in the treatment of cancer and viral diseases. Although the toxicity of these compounds can limit their usefulness, the antimetabolites will continue to play an important role in the treatment of cancer for the foreseeable future. It is likely that some of the new nucleoside analogues that are currently in the pipeline will be approved for use in the coming years. Although drug discovery is being pursued of new anticancer agents that target enzyme activities more closely associated with the cancer phenotype, the unpredicted toxicity of these new agents could still be a major issue of these agents as well. The design, synthesis, and evaluation of new purine and pyrimidine analogues is still a productive area for discovering new drugs for the treatment of cancer, since many years of knowledge with respect to their potential actions and toxicity has accumulated. Novel nucleoside analogues with unique actions are continuously being identified, and the information provided in this review indicates that small structural modifications of nucleoside analogues can have profound effects on their chemical stability and spectrum of biological activity.