Abstract: The application of microneedle technology in biomedicine has attracted widespread attention due to its versatility in tissue sampling, biosensing and drug delivery. In particular, drug-loaded microneedle formulations can directly penetrate the stratum corneum to deliver drugs, enhance drug delivery efficiency, and achieve the purpose of disease treatment, which is characterized by high efficiency, portability, low trauma, and high controllability. When combined with smart responsive materials, microneedles enable precise drug delivery, improving targeting accuracy for diseases such as tumors while minimizing toxic side effects on normal tissues and cells. In this review, we introduce the history of microneedle technology and highlight its applications in smart-responsive systems for oncology therapy. We also discuss the current challenges and obstacles faced by microneedle technology in oncology therapy and clinical translation. Finally, we provide prospective recommendations on the current situation, aiming to inspire new ideas and directions for the development of related technologies.