Unlocking the therapeutic potential of tumor-derived small extracellular vesicles in cancer immunotherapy: A multifaceted approach

Cancer immunotherapy represents a remarkable breakthrough in oncology. However, the efficacy of existing therapeutic modalities is observed in only a subset of patients, highlighting the need for further advancements. Tumor-derived small extracellular vesicles (T-sEVs), nano-sized extracellular vesicles secreted by cancer cells, have been the focus of significant interest as contributors to immunotherapy resistance. T-sEVs serve as biomarkers and therapeutic targets owing to their roles in mediating intercellular communication, promoting tumor progression and metastasis, and fostering immunosuppressive microenvironments that hinder immunotherapy. However, when appropriately utilized and their unique properties leveraged, T-sEVs exhibit therapeutic potential. This review explores the potential of T-sEVs as a multifaceted therapeutic option for enhancing cancer immunotherapies. It overviews the emerging research trends and applications of three main therapeutic strategies: eliminating immunosuppressive T-sEVs, utilizing T-EVs as drug carriers with tumor-targeting capabilities, and exploiting T-EVs as antigenic platforms to enhance anticancer immunity. In conclusion, the review provides insights into the potential clinical applications of T-sEV-based therapies and discusses future directions for their development.