Exosome-mediated communication in pancreatic cancer: From molecular crosstalk to clinical translation

Pancreatic cancer continues to be one of the most lethal cancers globally, with incidence rates closely mirroring mortality. This high fatality rate is largely due to late-stage diagnosis, when treatment options are limited. Efforts to reduce PC-related mortality have focused on enhancing early screening techniques and improving treatments for advanced-stage disease. Exosomes are extracellular vesicles released by cells that carry lipids, proteins, and nucleic acids to other cells, inducing phenotypic changes in the recipients. Tumor cells typically produce exosomes in greater quantities. Tumor-derived exosomes are now recognized as key contributors to the remodeling of the pancreatic cancer stroma, particularly in creating an immunosuppressive microenvironment. This has led to growing interest in their potential role as mediators of immunomodulatory effects for pancreatic cancer diagnosis. Researchers are currently exploring exosomes as nanocarriers capable of stimulating an immune response against tumors. The presented review examines recent updates on the role and mechanisms of exosomes in the biological functions of malignant tumor, highlighting their potential role in pancreatic cancer therapy, diagnostic imaging, and early detection biosensors. Finally, it examines clinical trials and explores the future prospects of exosomal therapies in pancreatic cancer treatment.