Unveiling the power of exosomal non-coding RNAs: key drivers of lung cancer progression in the tumor microenvironment

Lung cancer remains one of the deadliest malignancies worldwide, largely due to complex interactions within the tumor microenvironment (TME). Exosomes-small extracellular vesicles released by cancer cells-have emerged as crucial mediators of intercellular transfer. They carry non-coding RNAs (ncRNAs) that regulate tumor growth, metastasis, immune evasion, and treatment resistance. Among them, exosomal microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) play key roles in supporting tumor survival and modulating the TME. This study highlights the diverse functions of exosomal ncRNAs, emphasizing their potential as therapeutic targets and biomarkers in lung cancer. We explore how these molecules affect signaling pathways, immune responses, and chemoresistance, underlining their value in personalized therapy. Despite their promise, clinical translation remains challenging due to issues like exosome isolation, targeted delivery, and minimizing off-target effects. By integrating recent advances in exosomal ncRNA biology with innovative therapeutic strategies, this review addresses critical gaps in cancer research and supports the development of more effective, tailored treatments for lung cancer.