The advantageous biological properties of hydroxyethyl starch (HES) triggered research interest toward the design and synthesis of drug delivery systems (DDSs) based on this polysaccharide. Convenient reaction schemes, including one-step reactions, led to the synthesis of HES conjugates with selected anticancer molecules or therapeutic proteins. Nanocapsules and hydrogels based on HES were also prepared and studied as prospective drug delivery systems. Formulations originating from these drug conjugates and also from nanocapsules and hydrogels loaded with drugs were characterized, highlighting the extension of their half-life in plasma, which is a critical property as far as their efficacy is concerned. Results obtained in vitro and in vivo proved promising, justifying the undertaking of additional experiments with such systems, including their multifunctionalization. The promising formulations that are discussed in this Topical Review is expected to further increase interest in applying HES for molecular constructing novel DDSs with enhanced efficacy, which may, in the future, find clinical applications.