Cancer immunotherapy has emerged as one of the most promising modalities in the fight against malignancies. Among various therapeutic approaches, neoantigen-based vaccines have received considerable interest for their ability to deliver highly personalized treatments. Neoantigens are tumor-specific, mutated peptides resulting from somatic mutations in cancerous cells. They are identified by the immune system, positioning them as promising targets for immunotherapy. In this review, we explore the recent advances in the development of neoantigen-based vaccines, focusing on the strategies employed to identify, design, and deliver these vaccines. We also discuss the challenges faced in clinical application, including tumor heterogeneity, immune evasion, and vaccine delivery mechanisms. Lastly, we provide an overview of the clinical trials conducted to date and future directions on neoantigen-based cancer vaccines.