Exosomal delivery of non-coding RNAs: a pathway to apoptosis regulation in lung cancer

Exosomal non-coding RNAs (ncRNAs) play a key role in regulating apoptosis in lung cancer, influencing tumor progression and therapeutic resistance. This review examines how exosomal ncRNAs, including miRNAs, lncRNAs, and circRNAs, modulate apoptotic pathways in the tumor microenvironment. This review examines how exosomal ncRNAs, composed of three types, including miRNAs, lncRNAs, and circRNAs, control apoptotic pathways in the tumor microenvironment. A review of exosome-mediated ncRNA signaling developments published between 2015 and 2024 was obtained from PubMed, Scopus, and Web of Science databases. Exosomal ncRNAs use the BCL-2 and p53 and caspase apoptosis regulators as targets to function as oncogenic drivers or tumor suppressors. These vesicles function as intercellular messengers, helping cells to establish drug resistance features and to evade immune responses. The potential of exosomal ncRNAs serves both as liquid biopsy biomarkers for early detection of lung cancer and for prognosis monitoring. Targeting exosome-mediated ncRNA transfer represents a new therapeutic approach to reactivate apoptosis, which subsequently makes tumors more responsive to conventional medical therapies. In contrast to existing literature, we provide the first integrated comparison of exosomal miRNAs, lncRNAs, and circRNAs in lung cancer apoptosis, highlight novel mechanistic links between specific ncRNA cargos and key apoptotic mediators, and identify emerging exosomal ncRNA biomarkers with prognostic and therapeutic potential. Future scientific investigations must concentrate on building exosome-based delivery systems for applying precision medicine. The review establishes the translational potential of exosome-transferred ncRNAs in lung cancer diagnosis and therapy through their regulatory functions in apoptosis and therapeutic resistance.