Implantable hydrogel-based scaffold integrating cascaded chemotherapy and self-amplified immunotherapy to suppress postsurgical tumor recurrence.

Tumor recurrence following surgical resection remains a formidable clinical challenge, as conventional adjuvant therapies are often constrained by chemoresistance and chemotherapy-associated complications. To circumvent these limitations, we engineered a modular, three-dimensional (3D)-printed hydrogel-based scaffold for synergistic chemotherapy and immunotherapy. The scaffold, composed of soybean isolate protein, polyvinyl alcohol, sodium alginate, and magnesium acetate, was loaded with doxorubicin (DOX) and tirapazamine (TPZ) to establish a sequential therapeutic cascade. DOX exerts its antitumor effects through triple mechanisms: direct tumor cell cytotoxicity, tumor vasculature disruption, and immunogenic cell death (ICD) induction. However, its efficacy is frequently attenuated by tumor hypoxia, mediated through nicotinamide adenine dinucleotide phosphate hydride oxidases upregulation and vascular integrity compromise. The hypoxia-activated prodrug TPZ addresses this limitation through bioreduction to its cytotoxic metabolite, benzotriazinyl, thereby overcoming DOX resistance and potentiating ICD. Furthermore, magnesium acetate serves a dual immunomodulatory role by functioning as an immune adjuvant that facilitates CD8 T cell activation and promotes tumor-associated macrophage repolarization towards the M1 phenotype. This multifunctional dual-drug depot demonstrates potential as an effective therapeutic platform for preventing tumor recurrence and addressing the limitations of conventional postoperative therapies.