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Macrophages, sentinels of the innate immune system, are abundantly recruited to solid tumors, making them compelling candidates. Preclinical studies show that CAR\u2010engineered macrophages (CAR\u2010M) exhibit precise tumor homing, potent antigen\u2010directed phagocytosis, and the capacity to remodel immunosuppressive tumor microenvironments (TMEs). Notably, early\u2010phase clinical investigations indicate a favorable safety profile, strengthening confidence in their therapeutic potential against solid cancers. In this review, we synthesize design principles for CAR\u2010M constructs, with a particular focus on emerging engineering strategies for next\u2010generation CAR\u2010M. We further discuss their applications in oncology and emerging non\u2010oncologic indications, and summarize the current clinical trial landscape. We further propose a \u201c4S framework\u201d (specificity, switchability, synergy, and safety) to guide next\u2010generation CAR\u2010M development. 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