Superparamagnetic iron oxide (SPIO) nanoparticles have been extensively employed for theranostic applications due to their good biocompatibility and excellent magnetic resonance imaging (MRI) properties. However, these particles typically require surface modification due to their hydrophobic surfaces caused by the oil-phase surfactants used in the fabrication and thus, the drug loading on their surface is usually limited. Here, we provided a novel and facile approach to conveniently perform surface modification of SPIO while simultaneously loading a large amount of drug. By synthesizing an amphiphilic irinotecan-based compound with a hydrophobic tail enabling insertion into the SPIO assembly, an excellent SPIO-based theranostic nanomedicine (SPIO@IR) was produced. SPIO@IR not only extensively improved the drug efficacy, but also allowed visualization by MRI in biological systems.