Targeting extracellular vesicle-mediated tumor-immune symbiosis: From molecular mechanisms to translational implications.

Symbiotic interactions between tumor cells and immune cells are key drivers of tumor progression and treatment resistance. Extracellular vesicles (EVs) are key mediators of intercellular crosstalk within the tumor microenvironment. An increasing number of studies have demonstrated that EVs play a significant role in regulating tumor-immune symbiosis. Tumor cell-derived EVs can modulate the function of various immune cells within the microenvironment, mediating immune suppression and promoting tumor growth. Correspondingly, immune cells also produce EVs that promote malignant phenotypes in tumor cells, such as proliferation, invasion, epithelial-mesenchymal transition (EMT) and treatment resistance. Targeting EV-mediated tumor-immune symbiosis has emerged as a promising strategy in cancer therapy. In this review, we introduce the biogenesis and heterogeneity of EVs, highlighting the bidirectional pro-tumoral crosstalk between tumor cells and immune cells. Furthermore, we summarize current therapeutic strategies targeting EVs to break tumor-immune symbiosis and offer perspectives on future directions in this advancing field.