The quest for new medical drugs demands reliable, ultrasensitive and fast techniques to identify, refine and test small volumes of candidates for clinical trials. The efficacy of pharmaceuticals depends to a large extent on their chiral composition, and thus enantiomeric purity and selectivity is an important issue for the development of new drugs and to test their biotoxicity. TwistedNano addresses this need with a new generation of integrated nanophotonic devices enabling ultrasensitive chiroptical spectroscopy of sub-nanolitre volumes, revolutionizing at-source the sensing technological toolbox for drug discovery and nanomedicine. Because of governmental regulations, agencies require pharmaceutical manufacturers to investigate systematically most of drug enantiomers to determine their safety/efficacy. Thus, the development of fast, compact and accurate chiral sensing on a chip is one of the current primary targets of the nanomedicine industry, constituting a growing market that is already exceeding 100 billion Euros. TwistedNano will result in a photonics-enabled chiral sensing technology that integrates vectorial structured light fields with almost arbitrary control onto a microfluidic chip, providing groundbreaking advantages compared to current instrumentation: (i) remote/distributed analysis, (ii) reduced sample consumption, (iii) cost reduction, (iv) parallelization, (v) increased diagnostic speed and sensitivity. Key elements developed for optofluidic integration include photonic crystal fibers, photonic nanostructures, and metasurfaces operating in close synergy with cutting-edge chiroptical spectroscopic techniques. In the mid-term, TwistedNano will not only lay the foundations of a new lab-on-chip chiral sensing technology revolutionizing drug discovery, theranostics and nanomedicine, but also open a plethora of disruptive applications such as characterization of minute amounts of viruses and macromolecules in general.