Despite decades of effort, progress with therapeutic cancer vaccines has been limited by immune tolerance, heterogeneous antigenicity and modest clinical efficacy. However, recent advances in mRNA delivery, neoantigen prediction and rational immunotherapy combinations have shifted development toward more precise and programmable strategies (Nat. Rev. Cancer 25, 517–533; 2025). Here, we present an overview of clinical-stage vaccines, analysing the technology platforms, antigen selection and personalization approaches that could support the establishment of therapeutic cancer vaccines as a pillar of immuno-oncology.