ABSTRACT Equivariant graph neural networks (EGNNs) are becoming the geometric infrastructure of 3D molecular generation for AI‐aided drug discovery. By enforcing E(n), E(3), or SE(3) equivariance, they separate physical molecular structure from arbitrary coordinate‐frame conventions and ensure that predicted coordinates, denoising directions, and velocity fields transform consistently with molecular geometry. This symmetry‐aware design supports direct modeling of conformations and protein–ligand spatial relationships while remaining compatible with diffusion, flow‐based, autoregressive, and hybrid generative frameworks. Consequently, EGNNs enable more geometrically consistent generation and facilitate controllable design conditioned on binding pockets, pharmacophores, fragments, scaffolds, reference ligands, or molecular properties. Their benefits, however, are bounded by what equivariance encodes. Coordinate‐frame consistency does not itself enforce valid bonds, valence, stereochemistry, topology–geometry agreement, synthesizability, or biological activity. Moreover, practical models must reconcile discrete chemical variables with continuous geometric dynamics, represent long‐range interactions without prohibitive computational cost, and account for protein flexibility, solvent, metal ions, and induced fit. Performance is further constrained by biased docking or property predictors, heterogeneous benchmarks, and limited prospective validation. This review synthesizes how EGNNs function across major generative paradigms and argues that future drug‐oriented systems should combine joint 2D–3D graph generation, physically credible interaction modeling, synthesis and ADMET constraints, multi‐objective optimization, and closed‐loop experimental feedback. EGNNs should therefore be viewed not as a complete chemical solution, but as the symmetry‐aware foundation upon which more testable and biologically relevant molecular design systems can be built.
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