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Cancer theranostics have seen a surge in the use of metal-organic frameworks (MOFs) as multifunctional nanoplatforms due to their many desirable properties, including their malleability in terms of composition, structural diversity, and ease of functionalisation. Combining diagnostic and therapeutic characteristics into one system is possible due to their unique physicochemical qualities. Because of this, they are qualified to participate in precision oncology. Here we take a look at the latest developments in cancer theranostics using MOF-based nanomaterials and smart design. Improvements in biocompatibility, targeting, and cancer therapy efficacy are the primary goals. Nanoscale engineering, surface modification with targeted ligands, incorporation of imaging probes and therapeutic agents such as chemotherapeutic medications, photosensitisers, nucleic acids, and organic linkers are all crucial design considerations. To further achieve regulated drug release and improved therapeutic outcomes, the development of stimuli-responsive MOFs is investigated. These MOFs make use of tumor-specific conditions, such as acidic pH, enhanced redox potential, enzymatic activity, and external stimuli similar to light or ultrasound. Additionally, the integration of various imaging modalities, including photoacoustic imaging, computed tomography, fluorescence, and magnetic resonance imaging, is examined in order to enable the realtime tracking of therapeutic processes. When it comes to stability in physiological settings, biodegradability, and other issues, we take a close look at them. Future clinical applications of MOFbased theranostic systems are being considered. In sum, several approaches to design show that MOFs are very promising as platforms for cancer integrated diagnostics and treatment in the future.