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Cancer poses a global challenge in diagnostics and therapeutics. Treatments like chemotherapy, radiotherapy, surgery, and immunotherapy have significantly decreased the fatality rate, but drug resistance, therapy side effects, and relapse remain as major concerns. Live biotherapeutics are microorganisms that can be developed as therapeutic agents to modulate cancer pathophysiology and aid in disease management. Live biotherapeutic products (LBPs) have the potential to suppress tumour growth, enhance the effectiveness of conventional therapies, and reduce treatment-related side effects. Dysbiosis in the gut and cancer-specific tissues is linked to cancers of the colon, stomach, pancreas, and liver. Live biotherapeutics aim either to re-establish microbial balance or to employ microbes directly as anticancer tools. Both native and engineered LBPs (bacteria and viruses) represent promising interventions that may form part of next-generation cancer treatment strategies. Their clinical application draws on the integration of microbiology, immunology, synthetic biology, and oncology. LBPs can be used to target cancer cells by delivering antitumour payloads such as immune modulators, toxins, exposing cancer antigens, and molecules for targeted killing. LBPs offer advantages such as reduced systemic toxicity, overcoming drug resistance, and synergy with chemo-, radio-, and immunotherapies. Despite challenges in safety, manufacturing, regulation, and personalization, advances in synthetic biology and omics are enabling precision approaches. Future innovations such as bacteriobots, biocontainment systems, and patient-specific microbiome integration highlight their potential as next-generation cancer therapeutics.