Engineered macrophages represent a promising advancement in cancer immunotherapy, offering new strategies for targeting solid tumours. These cells, modified through genetic engineering, can serve as drug delivery systems, antigen-presenting cells, and immune modulators. The review highlights various approaches, including macrophage-based drug delivery systems, chimeric antigen receptor (CAR)-modified macrophages, and the use of bacterial outer membrane vesicles (OMVs) to enhance immunotherapy. Engineered macrophages can deliver drugs directly or indirectly, improve tumour targeting, and modulate the tumour microenvironment (TME) to enhance immune responses. CAR-M therapy, which involves modifying macrophages to express CARs, shows potential for targeting tumour antigens and polarizing macrophages towards an antitumour phenotype. OMVs, derived from gram-negative bacteria, can act as adjuvants and vaccine carriers, enhancing immune responses and promoting tumour-associated macrophage (TAM) reprogramming. Challenges remain, including understanding macrophage recruitment and polarization mechanisms, ensuring safety and efficacy, and overcoming clinical translation barriers. Future research aims to optimize engineered macrophage therapies, combine them with other treatments, and address technical and practical challenges to improve cancer immunotherapy outcomes.Engineered macrophages represent a promising advancement in cancer immunotherapy, offering new strategies for targeting solid tumours. These cells, modified through genetic engineering, can serve as drug delivery systems, antigen-presenting cells, and immune modulators. The review highlights various approaches, including macrophage-based drug delivery systems, chimeric antigen receptor (CAR)-modified macrophages, and the use of bacterial outer membrane vesicles (OMVs) to enhance immunotherapy. Engineered macrophages can deliver drugs directly or indirectly, improve tumour targeting, and modulate the tumour microenvironment (TME) to enhance immune responses. CAR-M therapy, which involves modifying macrophages to express CARs, shows potential for targeting tumour antigens and polarizing macrophages towards an antitumour phenotype. OMVs, derived from gram-negative bacteria, can act as adjuvants and vaccine carriers, enhancing immune responses and promoting tumour-associated macrophage (TAM) reprogramming. Challenges remain, including understanding macrophage recruitment and polarization mechanisms, ensuring safety and efficacy, and overcoming clinical translation barriers. Future research aims to optimize engineered macrophage therapies, combine them with other treatments, and address technical and practical challenges to improve cancer immunotherapy outcomes.