The effect of combined treatment with cold atmospheric plasma and doxorubicin on melanoma: a critical umbrella systematic review and meta-analysis of experimental studies

Objective: Melanoma is responsible for the majority of skin cancer deaths, but there are several ways to combat this deadly disease. One method involves the use of anti-neoplastic agents, such as doxorubicin (DOX). Unfortunately, DOX can be toxic and may lead to drug resistance. However, researchers are excited about the potential of cold atmospheric plasma (CAP) to selectively target cancer cells and overcome drug resistance. To gain a better understanding of the effectiveness of the combination of CAP and DOX on melanoma cell viability, cytotoxicity, and cell death, we conducted a comprehensive evaluation and meta-analysis in this study. Results: A total of 41 studies out of 121 met our inclusion criteria. Pooled analysis revealed that the CAP and DOX combination had a significant effect on cell viability (ES =6.75, 95% CI: 1.65--11.85, and I2 = 71%) and cytotoxicity (ES =11.71, 95% CI: 3.69--19.73, and I2 = 56%). However, no statistically significant association was found between cell death and thecombination treatment. Conclusions: Our studies confirmed that combined treatment with CAP and DOX has a synergistic effect on reducing cell viability and increasing cytotoxicity in melanoma cells. These results can assist researchers in selecting more effective treatment methods to address melanoma.