Engineering Extracellular Vesicles for Tumor Targeted Therapy: Source Optimization, Modification, and Clinical Application

Cancer remains a leading cause of global morbidity and mortality, yet conventional therapies, including surgery, radiotherapy, and chemotherapy, are often limited by invasiveness, systemic toxicity, and drug resistance. In this context, extracellular vesicles (EVs) have emerged as a promising cell-free nanotherapeutic platform. As endogenous nanocarriers, EVs enable precise, targeted delivery of diverse bioactive cargoes (eg, nucleic acids, chemotherapeutics, immunomodulators) to tumor tissues, thereby enhancing therapeutic efficacy while minimizing off-target effects, which is the key advantages for their application in tumor targeted therapy. This review systematically summarizes the characteristics of animal-derived and plant-derived EVs and highlights their translational applications in multiple cancers via immune activation, targeted delivery, tumor microenvironment remodeling, and anti-angiogenesis. We further introduce advanced bioengineering strategies for EV modification to optimize cargo loading, targeting specificity, and in vivo stability, particularly frontier innovations such as artificial intelligence-assisted design and microfluidic manufacturing that improve the precision, controllability, and scalability of engineered EVs. Compared to synthetic nanocarriers, EVs exhibit unique advantages, including excellent biocompatibility, low immunogenicity, and superior ability to cross biological barriers. However, the clinical application of EV-based therapies faces notable challenges, including EV heterogeneity, scalability of production, standardization of characterization methods, cargo loading efficiency, and long-term safety concerns. This review emphasizes the transformative potential of engineered EVs in advancing tumor targeted therapy and improving outcomes for patients with refractory or metastatic tumors.