Abstract:Podophyllotoxin is a natural product-derived drug with a long history of medicinal use, has led to the discovery of various derivatives in drug development. Despite their widespread clinical application, particularly in anti-tumor therapy, as tumor cells gradually develop resistance to podophyllotoxin and its derivatives during chemotherapy. Therefore, as tumor cells gradually develop resistance to podophyllotoxin and its derivatives during clinical chemotherapy, this review discuss the mechanisms of resistance to podophyllotoxin and its derivatives, providing references for predicting and avoiding resistance, and improving the clinical efficacy of podophyllotoxin and its derivatives.