Abstract: Cold atmospheric plasma (CAP) is a partially ionized gas that gains attention
as a well-tolerated cancer treatment that can enhance anti-tumor immune
responses, which are important for durable therapeutic effects. This review
offers a comprehensive and critical summary on the current understanding of
mechanisms in which CAP can assist anti-tumor immunity: induction of
immunogenic cell death, oxidative post-translational modifications of the
tumor and its microenvironment, epigenetic regulation of aberrant gene
expression, and enhancement of immune cell functions. This should provide
a rationale for the effective and meaningful clinical implementation of CAP. As
discussed here, despite its potential, CAP faces different clinical limitations
associated with the current CAP treatment modalities: direct exposure of
cancerous cells to plasma, and indirect treatment through injection of
plasma-treated liquids in the tumor. To this end, a novel modality is proposed:
plasma-treated hydrogels (PTHs) that can not only help overcome some of the
clinical limitations but also offer a convenient platform for combining CAP
with existing drugs to improve therapeutic responses and contribute to the
clinical translation of CAP. Finally, by integrating expertise in biomaterials and
plasma medicine, practical considerations and prospective for the
development of PTHs are offered.