Therapeutic potential of exosomes in malignancies: From drug delivery to clinical application

Cancer remains one of the most pressing global health challenges, with conventional treatments such as chemotherapy and radiotherapy constrained by modest efficacy and severe long‑term adverse effects. Exosomes-nano‑sized extracellular vesicles (30-150 nm) secreted by diverse cell types-have emerged as promising candidates for cancer diagnosis and therapy due to their inherent biocompatibility, low immunogenicity, and ability to cross biological barriers.

A comprehensive review of recent literature was conducted to summarize advancements in exosome biology, isolation techniques, and engineering strategies relevant to cancer nanomedicine. Particular emphasis was placed on ESCRT (Endosomal Sorting Complex Required for Transport) dependent biogenesis mechanisms, molecular cargo profiling, and applications in targeted drug delivery.

Tumor‑derived exosomes play multifaceted roles in cancer progression, including modulation of the tumor microenvironment, facilitation of metastasis, and induction of therapeutic resistance. Their molecular cargo-comprising proteins, lipids, and nucleic acids-serves as a dynamic reflection of the physiological or pathological status of the tumor cells. Technological innovations in exosome isolation, surface modification, and therapeutic payload loading have markedly improved targeted delivery and preclinical treatment outcomes. Notably, drug‑loaded exosomes demonstrate the ability to circumvent multidrug resistance.

Exosomes hold substantial promise for precision oncology through enhanced drug delivery and diagnostic applications. However, clinical translation requires standardized manufacturing, comprehensive safety profiling, and scalable production methods to address current limitations. Emerging strategies such as exosome mimetics and AI‑assisted production optimization poised to address these limitations, guiding the development of personalized, efficient, and targeted cancer treatments.