Insights into extracellular vesicle-based platforms on the way to cancer treatment

Exosomes are nanoscale extracellular vesicles (EVs) (≈30–150 nm) defined by a lipid bilayer that encloses an aqueous interior. This amphiphilic architecture permits the simultaneous encapsulation of hydrophobic, hydrophilic, and amphipathic compounds. Their endogenous biogenesis results in high biocompatibility, negligible immunogenicity, and the capacity to evade rapid clearance while crossing biological barriers. Additionally, the Surface antigens retained from the cell of origin provide exosomes with innate specificity, enabling efficient uptake by specific cell subpopulations. Studies have successfully engineered exosomes to transport inorganic nanoparticles, chemotherapeutic drugs, nucleic acids, and contrast agents, resulting in enhanced therapeutic efficacy and diagnostic sensitivity. Hybrid exosome systems, which integrate exosomes with supplementary carriers such as polymers, lipids, and nanoparticles, have been developed to further enhance their efficacy and expand the translational potential of exosome-based nanomedicine. A comprehensive literature search was conducted across PubMed, Scopus, and Google Scholar to identify relevant studies focusing on the therapeutic and diagnostic applications of exosomes in cancer, including engineered and hybrid exosome systems. It was extended to include the most recent publications up to and including those released in 2025. Full texts were reviewed to extract key information regarding study design, exosome source and modification, cargo type, delivery mechanism, and reported outcomes. Research has shown that exosomes can efficiently deliver therapeutic agents, greatly improving the effectiveness of targeted cancer treatments and the accuracy of diagnostics. Particularly, hybridized exosome-based systems have exceeded traditional techniques. Despite the limitations, such as the high expense and difficulty of accurate characterization, exosome-based systems have successfully penetrated various domains, including medication and gene delivery, diagnostics, and the development of hybrid carriers. Exosomes represent a flexible and promising platform for cancer diagnostics and treatment. Recent developments, particularly of hybrid exosome systems, have further boosted their therapeutic versatility and addressed some of the most significant drawbacks of native exosome technologies. Nevertheless, several challenges remain to be overcome, including the costly nature of purification, standardization of characterization methods, and safety issues and potential side effects. Overcoming these obstacles will ensure the clinical translation of exosome-based therapy.