The convergence of nanotechnology and metal-based materials has opened new avenues in drug delivery, offering novel strategies to significantly enhance therapeutic efficacy and targeting precision. The distinctive physicochemical properties of metal-based nanomaterials, such as gold nanoparticles, iron oxide nanoparticles, and metal-organic frameworks, are leveraged to enable the development of sophisticated platforms for targeted delivery, controlled release, and integrated theranostics. This review critically examines key fabrication approaches, advanced characterization techniques, and the diverse applications of metal-based nanomaterials. These encompass drug delivery, photothermal therapy, radiotherapy sensitization, immunotherapy and multimodal therapy. Furthermore, it addresses the pivotal challenges impeding clinical translation. The promising prospects of these technologies underscore their transformative potential in revolutionizing personalized medicine and diagnostic paradigms.