Extracellular Vesicles and Their Multifaceted Roles in Cancer: Current Evidence from a Narrative Review

Extracellular Vesicles (EVs), including exosomes and microvesicles, are nanoscale, lipid bilayer-enclosed particles released by diverse cell types. They play a key role in intercellular communication by transferring proteins, lipids, and nucleic acids. In cancer, EVs contribute to remodelling the tumor microenvironment, enhancing angiogenesis, modulating immune responses, promoting metastasis, and driving therapeutic resistance.

This narrative review aims to highlight the biological importance and clinical relevance of EVs in cancer, focusing on their potential as biomarkers and therapeutic tools.

A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science. Studies on EV composition, isolation, and characterization methods, as well as recent advances in EV bioengineering, were critically examined to summarize their significance in oncology.

Findings reveal that the molecular cargo of EVs reflects the physiological and pathological states of their source cells, supporting their role as non-invasive biomarkers for cancer detection and monitoring. EVs also regulate signaling pathways that sustain tumor heterogeneity and adaptability. Moreover, engineered EVs demonstrate strong potential as delivery systems for chemotherapeutic agents, RNA-based drugs, and immunomodulators, underscoring their translational value in targeted therapy.

EVs represent versatile tools in precision oncology. Although standardization and clinical validation remain challenges, ongoing research and technological progress may establish EV-based strategies as integral components of personalized cancer treatment.