Extracellular Vesicles as Promising Carriers in Cancer Therapy: Molecular Mechanisms of Biogenesis, Targeting, and Intracellular Action

Cancer therapy is increasingly shifting towards targeted strategies capable of maximizing therapeutic efficacy while minimizing off-target toxicity. Extracellular vesicles (EVs), including exosomes and microvesicles, have emerged as promising natural nanocarriers due to their characteristics like biocompatibility, stability in biological fluids, and capacity for selective cargo delivery. EVs participate in intercellular communication through highly regulated biological processes that control their formation, cargo selection, cellular uptake, and downstream signaling activity. This mini-review highlights how regulated sorting processes, surface-associated tropism, and diverse internalization pathways determine EVs specificity and functional impact in recipient tumor cells. Furthermore, current advances in engineering EVs for drug and RNA delivery, emphasizing their potential to enhance therapeutic precision while minimizing systemic toxicity, are summarized here. In conclusion, by linking fundamental molecular mechanisms to translational applications, EVs emerge as a promising platform for the development of targeted and biologically compatible cancer therapies.