Abstract: mRNA-targeted tumor drugs, featuring various types and distinct antitumor mechanisms of action, have demonstrated significant potential in tumor immunotherapy. Currently, nearly one hundred registered clinical trials initiated by pharmaceutical companies or sponsors are being conducted worldwide, and these trials have shown impressive efficacy. In China, multiple registered clinical trials have been conducted in the past two years, reflecting rapid development. Although mRNA tumor drugs still face certain challenges, the advantages of mRNA technology are clear, promoting the integrated development of immunotherapy, gene therapy, and cell therapy. With ongoing technological innovation and optimization, the demand for “mRNA therapy” for tumor prevention and treatment is expected to be met. This review discusses the distinct mechanisms of action, progress in basic research, clinical advancements, challenges, and future perspectives of both prophylactic and therapeutic mRNA cancer vaccines. It aims to enhance understanding of research progress in mRNA technology for oncological drug applications and to provide insights for future research and product development of mRNA-based interventions in oncology.