Hydrogen sulfide (H2S), once regarded solely as a toxic gas, has emerged as a star molecule for potential anticancer therapy. However, precise spatiotemporal control of H2S delivery remains challenging due to rapid diffusion and systemic toxicity risks. Recent advances in nanotechnology have enabled the design of H2S-generating nanomedicines (HSGNs) that address these limitations through stimuli-responsive in situ H2S generation. Through engineered design, HSGNs with different in situ generation mechanisms (such as pH and GSH responses) can be designed to improve the controlled release of H2S within cells effectively, and considerable efforts have been made to explore their multimodal synergistic effects in cancer therapy. This review systematically examines the development of HSGNs, focusing on material innovations, controlled-release strategies, and multimodal therapeutic applications in cancer treatment, and, finally, provides a prospective view of the future development of HSGNs to accelerate their practical clinical translation and application.