Bis(2,6-dioxopiperazines) and other catalytic inhibitors of mammalian DNA topoisomerase II have recently been found in natural and synthetic compounds. These compounds target the enzyme within the cell and inhibit various genetic processes involving the enzyme such as DNA replication and chromosome dynamics and thus proved to be good probes for the functional analyses of the enzyme in a variety of eucaryotes from yeast to mammals. Catalytic inhibitors were shown to be antagonists against topoisomerase II poisons under some conditions, but to be synergistic under others. Bis(2,6-dioxopiperazines) have a potential to overcome cardiac toxicity caused by potent antitumor anthracycline antibiotics such as doxorubicin and daunorubicin. ICRF-187, +enantiomer of racemic ICRF-159, has been used in EU countries as cardioprotector in cancer clinics. Furthermore, bis(2,6-dioxopiperazines) enhance the efficacy of antitumor topoisomerase II poisons, e.g. anthracycline antibiotics such as daunorubicin and doxorubicin, by reducing their side effects and by allowing dose escalation of the antitumor drugs in preclinical and clinical settings. Besides bis(2,6-dioxopiperazines) per se having antitumor activity, and one of their derivatives, MST-16 or sobuzoxane, bis(N1-isobutyloxycarbonyloxymethyl-2,6-dioxopiperazine), has been developed in Japan and used in clinics as anticancer drug for malignant lymphomas and adult T-cell leukemia (ATL). Further developments of bis(2,6-dioxopiperazines) as antimetastatic agents are expected.