Exosomal biomarkers and therapeutics in lung cancer: a narrative review on their role in early detection and targeted treatment.

Background and Objective: Lung cancer remains the leading cause of cancer-related mortality worldwide, largely due to late-stage diagnosis and therapy resistance. Despite advances in targeted therapies and immunotherapies, the prognosis remains poor. There is a critical need for minimally invasive biomarkers that enable early detection, prognostic stratification and therapeutic monitoring. Exosomes, a subtype of extracellular vesicles, have emerged as promising candidates in this context given their role in intercellular communication and their selective cargo, which reflects the molecular state of tumor cells. This review aims to summarize the current evidence on the potential of exosomes and their cargo, particularly microRNAs (miRNAs), as diagnostic and prognostic biomarkers as well as therapeutic tools in lung cancer. Methods: A comprehensive literature search was conducted using PubMed/MEDLINE and Scopus databases between January 3 and April 30, 2025. Studies published from January 2000 to April 2024 were included if they addressed the role of exosomes in lung cancer diagnosis, prognosis, or therapy. Two reviewers independently screened titles and abstracts and full texts were assessed based on predefined inclusion criteria. Relevant articles were also identified through reference lists. Key Content and Findings: Exosomal miRNAs (microRNAs) have shown potential as biomarkers for early detection, disease subtype classification, prognosis and therapy resistance in lung cancer. Multiple studies have identified specific miRNA signatures associated with tumor burden, histological subtypes and clinical outcomes. Exosomes also contribute actively to oncogenesis through promoting angiogenesis, epithelial-mesenchymal transition, immune evasion and drug resistance. Furthermore, exosomes are being investigated both as therapeutic targets and delivery systems due to their ability to transfer functional biomolecules selectively and safely. Despite these advances, challenges remain regarding standardization of isolation methods, heterogeneity in miRNA signatures and clinical validation. Conclusions: Exosomes represent a dynamic and promising platform for improving the diagnosis, prognosis and treatment of lung cancer. Although technical and translational hurdles remain, their integration into clinical practice may enhance personalized and precision oncology strategies. Continued research and technological advancements are necessary to fully unlock their potential in routine cancer care.