The discovery of cisplatin has triggered research in metal‐based anticancer agents. Ruthenium complexes have been investigated as chemotherapeutics for more than 30 years. In this article, we review the early steps of Ru‐based drug development, which was often based on the structural similarity to cisplatin, and led eventually to the clinical trials of KP1019/KP1339 and NAMI‐A and the emergence of the organometallic RAPTA and RAED compound series. The unique modes of action of Ru compounds equip them with their special pharmacological properties. Especially in the past decades, many rationally designed Ru complexes have been reported to expand the range of compound types, and therewith the modes of action these compounds follow. This article covers many of the reported novel approaches and newer developments in the field, demonstrating in some cases properties advantageous to that of platinum anticancer agents and opening the route to new generations of metal‐based anticancer agents.