# Extracellular Vesicles in Cancer: Mechanistic Insights and Clinical Applications

## TL;DR

Extracellular vesicles (EVs) play key roles in cancer progression and offer potential as biomarkers and drug delivery tools, though challenges remain in their clinical application.

## Contribution

This review provides a comprehensive overview of EVs' roles in cancer and highlights recent advances in their clinical applications.

## Key findings

- EVs influence cancer hallmarks like angiogenesis, immune evasion, and metastasis.
- EVs are stable in body fluids and reflect tumor molecular profiles, making them promising biomarkers.
- EVs can be engineered for targeted drug delivery and immunotherapy.

## Abstract

Extracellular vesicles (EVs) are increasingly recognized as critical regulators of cancer biology, facilitating intercellular communication through the transfer of bioactive cargo, such as nucleic acids, proteins, and lipids. EVs derived from tumor cells and components of the tumor microenvironment (TME) influence multiple hallmarks of cancer, including angiogenesis, immune modulation, extracellular matrix remodeling, metastatic niche formation, and therapeutic resistance. Their capacity to reflect tumor-specific molecular alterations and remain stable in body fluids highlights their potential as minimally invasive biomarkers for cancer detection and disease monitoring. Moreover, advances in EV engineering have opened new opportunities for their use as targeted drug delivery systems and immunotherapeutic platforms. Despite these advances, challenges related to EV heterogeneity, isolation methods, scalability, and clinical standardization continue to limit translation into routine oncology practices.

Extracellular vesicles (EVs) have emerged as important messengers in cell-to-cell communication, carrying biologically active molecules such as lipids, nucleic acids, and proteins that influence both normal physiology and disease. In cancer, EVs play complex and context-dependent roles, contributing to tumor growth, angiogenesis, immune evasion, metastasis, and resistance to therapy, while in certain settings, they may also support antitumor immune responses. Increasing evidence shows that EVs released from tumor and stromal cells actively reshape the tumor microenvironment (TME) and participate in the formation of pre-metastatic niches, thereby facilitating cancer dissemination. Because EVs are stable, readily detectable in body fluids, and reflect the molecular characteristics of their cells of origin, they have attracted considerable interest as minimally invasive biomarkers for cancer diagnosis, prognosis, and treatment monitoring. In addition, their natural biocompatibility makes them attractive candidates for targeted drug delivery. This review summarizes current knowledge on EV biogenesis, cargo composition, and functional roles in cancer progression, with a particular focus on recent advances in their clinical applications. Key challenges related to EV isolation, characterization, and clinical translations are also discussed, highlighting future opportunities for integrating EV-based strategies into precision oncology.