Exosome-based vaccines in cancer immunotherapy: antitumor mechanisms, engineering strategies, and challenges

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Exosome-based vaccines hold significant promise in cancer immunotherapy, yet their native forms face inherent challenges, including imprecise targeting, suboptimal immunogenicity, and poor controllability of antigen loading. This review posits that engineering is pivotal to transforming exosomes from passive carriers into active, programmable therapeutic platforms. We systematically dissect the multifaceted antitumor mechanisms of exosomes and critically evaluate how various engineering strategies (e.g., physical loading, genetic modification, membrane functionalization) are designed to address these specific biological bottlenecks, thereby establishing a coherent "biological limitation-engineering solution" framework. Building on this foundation, we assess their application potential and ongoing challenges in areas such as personalized neoantigen vaccines.

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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