Dual Roles of Exosomes in Precision Cancer Diagnosis and Therapy

Abstract

As core subsets of extracellular vesicles, exosomes mediate intercellular signal communication and carry diverse biomolecules that faithfully reflect the phenotypic characteristics of parent cells. In oncology research, exosomes exert two opposing biological effects on tumor progression and clinical intervention. This paper systematically sorts the dual regulatory functions of exosomes and summarizes their translational prospects for tumor liquid biopsy and targeted drug delivery. Tumor-derived exosomes remodel local and distant tumor microenvironments, suppress anti-tumor immune responses, facilitate angiogenesis and epithelial-mesenchymal transition, and transmit drug-resistant traits to sensitive tumor cells. Meanwhile, exosomes with intact lipid bilayer structures can protect internal nucleic acids and proteins from enzymatic degradation, serving as stable non-invasive biomarkers for early tumor screening and efficacy monitoring. Genetically modified engineered exosomes can load chemotherapeutics, small interfering RNAs and immune regulators to achieve tumor-specific targeted delivery. This paper systematically elaborates the molecular mechanisms, clinical diagnostic value, therapeutic potential and translational bottlenecks of exosomes in precision oncology. Current evidence proves exosome-based liquid biopsy supports early tumor detection, primary lesion tracing and dynamic efficacy evaluation. However, standardized separation protocols, unified quality control standards and long-term safety evaluation systems have not been fully established, restricting large-scale clinical transformation. Follow-up interdisciplinary research needs to form unified technical specifications to promote the clinical application of exosome-based diagnosis and treatment integrated strategies.