Currently, surgery, radiation therapy, and chemotherapy alone or in combination are the most common methods for cancer treatment. However, conventional therapies often lack cancer selectivity, which can result in severe adverse effects. Although many efforts have been made, effective and targeted approaches to cancer treatment are still needed. One promising avenue involves harnessing the potential of bacteria for cancer therapy. In this chapter, we summarize recent advancements and future perspectives on bacteria-based strategies for cancer treatment. Central to the success of such strategies is the critical role played by genetic engineering and bacterial modification in ensuring safety and precision in the complex in vivo environment. Moreover, we review the potential for synergistic combination therapies, which integrate bacterial approaches with conventional treatments like chemo-, immuno-, and radiation therapy. This chapter also sheds light on the current status of research and development in the field, spanning preclinical investigations, animal models, and the transition to clinical trials and human applications, as well as future directions and remaining challenges will also be discussed.