Versatile strategies have been developed to construct electrospun fiber-based drug delivery systems for tissue regeneration and cancer therapy. We first introduce the construction of electrospun fiber scaffolds and their various structures, as well as various commonly used types of drugs. Then, we discuss some representative strategies for controlling drug delivery by electrospun fibers, with specific emphasis on the design of endogenous and external stimuli-responsive drug delivery systems. Afterwards, we summarize the recent progress on controlling drug delivery with electrospun fiber scaffolds for tissue engineering, including soft tissue engineering (such as skin, nerve, and cardiac repair) and hard tissue engineering (such as bone, cartilage, and musculoskeletal systems), as well as for cancer therapy. Furthermore, we provide future development directions and challenges facing the use of electrospun fibers for controlled drug delivery, aiming to provide insights and perspectives for the development of smart drug delivery platforms and improve clinical therapeutic effects in tissue regeneration and cancer therapy. Graphical abstract