Background: Despite significant advances in oncology, cancer remains a leading cause of global mortality, with conventional therapies constrained by non-specific toxicity, drug resistance, and limited tumour penetration. Nanomaterials have emerged as transformative platforms for precision oncology, yet the rapid proliferation of nanocarrier designs has created a fragmented literature landscape that obscures translational priorities. Methods: Relevant literature published between 2020 and 2026 was identified through searches of major scientific databases, including PubMed, Scopus, and Web of Science. Peer-reviewed articles addressing nanomaterial-based approaches for cancer therapy, imaging, immunotherapy, and theranostics were evaluated. Information regarding nanocarrier design, mechanisms of action, targeting strategies, therapeutic performance, clinical translation, and regulatory considerations was synthesized to provide a comprehensive overview of recent developments in anticancer nanomedicine. Results: A broad body of recent literature was evaluated to identify major trends, opportunities, and challenges in anticancer nanomedicine. Lipid-based nanoparticles (LNPs) demonstrated the highest clinical translation rate (representing approximately 38% of clinically approved nanomedicine platforms), while polymeric systems showed superior drug loading efficiency (up to 45% w/w). Metallic nanoparticles excelled in theranostic applications but exhibited persistent concerns regarding long-term accumulation. Active targeting strategies improved tumour specificity by 2.3–4.1-fold compared to passive EPR-dependent approaches, though clinical validation remains limited. Only 14 nanoformulations have received regulatory approval for oncology indications, with manufacturing scalability and regulatory pathway uncertainty identified as primary translational barriers. Conclusion: This review introduces a Clinical Readiness Scoring System (CRSS) to stratify nanomaterials by translational potential, identifying lipid-mRNA platforms, stimuli-responsive polymeric micelles, and biomimetic cell-membrane-coated nanoparticles as the most promising candidates for near-term clinical impact. Furthermore, we identify a critical paradigm shift from subcutaneous xenograft optimization to orthotopictumour microenvironment-informed design, providing actionable guidance for prioritizing nanomedicine platforms with the highest probability of clinical success. This framework enables rational prioritization of nanocarrier platforms for clinical translation, shifting the field from innovation-driven to translation-driven development.
