Chemotherapy can prolong survival of patients with brain tumours. Temozolomide with radiotherapy is the standard of care in glioblastoma following surgery. Elderly patients with MGMT-promotor methylated tumours benefit more from chemotherapy than radiotherapy. Localized delivery of chemotherapy-soaked wafers (Gliadel®) inserted at surgery has being investigated. At recurrence, modest survival advantage has been shown with chemotherapy. Chemotherapy has an established role in lower grade tumours. Stratification of tumours by their molecular profiles allows identification and selection of patients more likely to benefit from chemotherapy. Increased understanding of brain tumours and their microenvironment have led to the investigation of targeted therapies and immunotherapy, which are likely to form the basis of future treatment regimens.