The past few decades have witnessed the flourish of creating metal oxides for biocatalytic therapeutics due to their structural diversities, feasible modifications, tunable catalytic sites, and low cost when compared to their natural enzyme counterparts. Here, in this timely review, the most recent progress and future trends in engineering tunable structured metal oxides and decoding their structure‐reactivity relationships for biocatalytic therapeutics is comprehensively summarized. At first, the fundamental activities, evaluations, and mechanisms of metal oxide‐based biocatalysts are carefully disclosed. Subsequently, the merits, design methods, and state‐of‐art achievements of different types of nanostructured and biofunctionalized metal oxides are thoroughly discussed. Thereafter, it provides detailed comments on the catalytic center modulation strategies to engineer metal oxides for efficient reactive oxygen species (ROS)‐catalysis, including atomic catalytic site engineering, heterostructures, and support effects. Furthermore, the representative applications of these ROS‐catalytic metal oxides have been systematically summarized, such as catalytic disinfections, cancer therapies, ROS scavenging and anti‐inflammations, biocatalytic sensors, as well as corresponding toxicities. Finally, current challenges and future perspectives are also highlighted. It is believed that this review can provide cutting‐edge and multidisciplinary instruction for the future design of ROS‐catalytic metal oxides and stimulate their widespread utilization in broad therapeutic applications.