Background/Objectives: Natural products exhibit significant immunomodulatory potential but face severe efficacy loss in three-dimensional (3D) tumor models. This review comprehensively examines the penetration–activity trade-off and proposes integrated strategies for developing effective natural product-based cancer immunotherapies. Methods: We analyzed formulation strategies across three natural product categories (hydrophobic, macromolecular, stability-sensitive), evaluating penetration enhancement versus activity preservation in spheroids, organoids, and advanced 3D platforms. Results: Tumor spheroids present formidable barriers: dense extracellular matrix (33-fold increased fibronectin), pH gradients (7.4 → 6.5), and extreme cell density (6 × 107 cells/cm3). While nanoparticles, liposomes, and cyclodextrins achieve 3–20-fold penetration improvements, biological activity frequently declines through conformational changes, incomplete release (10–75%), and surface modification interference. Critically, immune cells remain peripheral (30–50 μm), questioning deep penetration pursuit. Patient-derived organoids display 68% predictive accuracy, while emerging vascularized models unveil additional complexity. Food and Drug Administration (FDA) Modernization Act 2.0 enables regulatory acceptance of these advanced models. Conclusions: Effective therapeutic outcomes depend on maintaining immunomodulatory activity in peripherally-located immune cell populations rather than achieving maximum tissue penetration depth. Our five-stage evaluation framework and standardization protocols guide development. Future priorities include artificial intelligence-driven optimization, personalized formulation strategies, and integration of multi-organ platforms to bridge the critical gap between enhanced delivery and therapeutic efficacy.
Hong et al. (2025) studied this question.