Cell membrane engineering has revolutionized the advancement of nanosystems for precision drug delivery in cancer therapy, offering unparalleled opportunities for tumor targeting. By leveraging the biological attributes of membranes derived from red blood cells, platelets, immune cells, cancer cells, exosomes, and bacterial cells, researchers have created biocompatible, immune-evasive carriers tailored for specific tumor environments. This chapter delves into the fabrication of membrane-coated nanosystems, detailing key steps such as membrane isolation, coating processes, and advanced physicochemical and biological characterization techniques. Special emphasis is placed on cutting-edge cell membrane engineering approaches, including lipid insertion, membrane hybridization, covalent conjugation, metabolic glycoengineering, and genetic modifications, which enable precise surface customization to enhance tumor interaction, payload delivery, and therapeutic efficacy. The versatility of these systems is demonstrated through their applications in chemotherapy, photothermal therapy, and immunotherapy, showcasing their ability to overcome challenges posed by the tumor microenvironment. This chapter highlights the transformative potential of engineered cell membranes to improve cancer treatment outcomes while addressing challenges in scalability and clinical translation. By integrating natural biomaterials with innovative engineering techniques, these systems offer a promising platform for advancing precision oncology and achieving enhanced therapeutic outcomes.