Macromolecular and colloidal systems used for the systemic delivery of drugs and genes promise to improve the way we treat and prevent numerous diseases. New generations of drug and gene delivery systems (DGDS) are being designed to enhance further efficiency by using a range of endogenous and external stimuli. This review focuses on three qualitatively distinct ways a stimulus can improve the efficiency of DGDS; namely, by selectively triggering release of the therapeutic agent from the DGDS, by modulating physical properties of DGDS and by favourably altering physiological properties of tissues to enhance DGDS transport. Recent developments in these areas are discussed to illustrate the potential of stimulus-controlled DGDS in the development of new generations of therapeutics.