Cephafortunoids A–D (1–4), four new compounds, together with ten known ones (5–14), were isolated from the branches and leaves of Cephalotaxus fortunei var. alpina. 1 and 2 represent the first examples of Cephalotaxus troponoid diterpenoids featured an intact C20 skeleton with CH3-17 migrating to C-15 and C-13 respectively. 3 and 4 are novel cephalotane-type diterpenoids with an epoxy ring between C-12 and C-13. The structures of isolated compounds were established by extensive spectroscopic methods, electronic circular dichroism (ECD) calculations, and comparison with reported data. In in vitro bioassays, all isolated compounds were evaluated for their cytotoxic activities against human promyelocytic leukemia cells (HL-60), human acute monocytic leukemia cells (THP-1), human breast cancer cells (MDA-MB-231), and human prostate cancer cells (PC-3). 5–9 exhibited prominent cytotoxicity against HL-60 and THP-1 with GI50 values of 0.27–5.48 and 0.48–7.54 μM, respectively. 5–8 showed evident cytotoxicity against MDA-MB-231 and PC-3 with IC50 values of 1.96–10.66 and 2.72–13.99 μM, severally. 6 with an IC50 value of 2.72 ± 0.35 μM displayed stronger cytotoxicity against PC-3 than the positive control etoposide. The structure-activity relationship of these compounds and plausible biogenetic pathways for 1–4 were discussed.