Another, arguably even more powerful, alternative is Rhino + Grasshopper. Grasshopper is often used for generative designs, but can include arbitrary Python nodes and can even be used for "parametrically" designed functional parts.

Grasshopper can also output gcode directly [1], enabling pretty wild things like [2].

[1]: https://interactivetextbooks.tudelft.nl/rhino-grasshopper/Gr...

[2]: https://www.instagram.com/medium_things/