In recent years, neoantigens have started a new chapter of individualized immunotherapy. As an important component of neoantigen-based individualized immunotherapy, neoantigen-specific T-cell adoptive transfer (ACT) has attracted much attention. This paper will first introduce the current development of neoantigen-specific T-cell ACT therapy, an emerging precision immunotherapy, in terms of application strategies and current clinical applications of neoantigen-specific T-cell ACT therapy. Then, the obstacles and challenges faced by neoantigen-specific T-cell ACT therapy will be systematically summarized in terms of neoantigen prediction, neoantigen-specific T-cell screening, and expansion. Finally, future development opportunities and research directions will be highlighted in five aspects, including optimizing neoantigen prediction, increasing the number and diversity of neoantigen-specific T cells, and preventing excessive differentiation or death of neoantigen-specific T cells, shortening the production cycle and reducing production cost, and exploring combination therapy modalities.