Exercise-derived extracellular vesicles in oncology: a new frontier for translational nanomedicine

BACKGROUND: Exercise-derived extracellular vesicles (ExEVs) have emerged as pivotal mediators of the systemic benefits associated with physical activity (PA). Growing evidence highlights their involvement in modulating cancer biology, enhancing immune surveillance, and alleviating treatment-related toxicity. MAIN BODY: Recent preclinical studies have begun to unravel the molecular composition and functional characteristics of ExEVs, suggesting considerable potential as both biomarkers and therapeutic agents in oncology and cardio-oncology. There is also increasing interest in the development of extracellular vesicle-inspired nanotherapeutics, with the goal of replicating the anticancer and cardioprotective benefits observed with PA in patients with cancer. While these approaches show promise, significant translational challenges persist, including heterogeneity among vesicle populations, manufacturing complexities, and unresolved regulatory questions. CONCLUSIONS: To address these barriers, a coordinated strategy is necessary. This should include the establishment of standardized protocols, promotion of interdisciplinary collaboration, and integration with personalized oncology frameworks. Progress in the therapeutic application of ExEVs may ultimately facilitate the development of innovative, low-toxicity interventions for cancer care.