Necrosis is a common feature of solid tumours that offers a unique opportunity for targeted cancer therapy as it is absent from normal healthy tissues. Tumour necrosis provides an ideal environment for germination of the anaerobic bacterium
Clostridium
from endospores, resulting in tumour-specific colonisation. Two main species,
Clostridium novyi
-NT and
Clostridium sporogenes
, are at the forefront of this therapy, showing promise in preclinical models. However, anti-tumour activity is modest when used as a single agent, encouraging development of
Clostridium
as a tumour-selective gene delivery system. Various methods, such as allele-coupled exchange and CRISPR–cas9 technology, can facilitate the genetic modification of
Clostridium
, allowing chromosomal integration of transgenes to ensure long-term stability of expression. Strains of
Clostridium
can be engineered to express prodrug-activating enzymes, resulting in the generation of active drug selectively in the tumour microenvironment (a concept termed
Clostridium
-directed enzyme prodrug therapy). More recently,
Clostridium
strains have been investigated in the context of cancer immunotherapy, either in combination with immune checkpoint inhibitors or with engineered strains expressing immunomodulatory molecules such as IL-2 and TNF-α. Localised expression of these molecules using tumour-targeting
Clostridium
strains has the potential to improve delivery and reduce systemic toxicity. In summary,
Clostridium
species represent a promising platform for cancer therapy, with potential for localised gene delivery and immunomodulation selectively within the tumour microenvironment. The ongoing clinical progress being made with
C. novyi
-NT, in addition to developments in genetic modification techniques and non-invasive imaging capabilities, are expected to further progress
Clostridium
as an option for cancer treatment.