AbstractContinuous cultivation of mammalian cells originated in chemostats in the 1950s and, through a series of technological advancements, has evolved into modern‐day high‐density perfusion processes with volumetric productivities >5 g L–1 day–1over extended cultivation periods. With appropriate process development, these productivities can be achieved with no adverse impact on cell line stability and product quality. Developments in downstream processing and automation have enabled the integration of drug substance manufacturing processes suitable for next‐generation plants that require lower capital deployment, with the potential for rapid construction and validation for clinical and commercial production. Perfusion also has been successfully used to generate high‐density cell banks (> 50 × 106cells mL–1) and for seed‐train optimization. They have resulted in significant productivity increases (10‐fold increase in volumetric productivity) from fed‐batch bioreactors by providing a high‐density seeding culture that elevates the inoculation density in a production bioreactor (> 5 × 106cells mL–1). Related advancements in cell culture medium formulations and cell line performance typically are independent of bioreactor format and have broad applicability for biotherapeutic manufacturing. The last decade has seen renewed interest in high‐density perfusion cultures and technological advances spanning the entire space of drug substance manufacturing – from cell line development to the final purification step. Continually evolving, these new technologies now are being introduced into clinical and commercial manufacturing. We anticipate that the general principles and knowledge gleaned from process intensification will extend well beyond classical perfusion cultivation and into all aspects of mammalian cell culture. © 2021 Society of Chemical Industry (SCI).