<p>Antimicrobial peptides (AMPs) are a class of naturally occurring short peptide chains with a broad spectrum of biological activities, especially showing unique potential in cancer treatment. Its ability to selectively kill tumor cells makes it a research hotspot for anticancer therapy. However, the issues of stability, selectivity and toxicity of AMPs in clinical applications still need to be addressed. This review summarizes the current status of engineering and optimization design of antimicrobial peptides, focusing on ways to improve their biostability, anticancer selectivity and reduce host toxicity through chemical modification, sequence optimization and multifunctional strategies. Furthermore, the design concept of novel stimulus-responsive antimicrobial peptides and their application prospects in targeted therapy are presented. Future research should focus on intelligent design, development of integrated treatment platforms, and innovation in industrial production technologies. Through multidisciplinary collaboration and technological breakthroughs, antimicrobial peptides are expected to play a greater role in cancer therapy and other biomedical fields, providing new solutions for personalized medicine and precision therapy.</p>