Exosomal Communication in the Tumour Microenvironment of Non-small Cell Lung Cancer: Implications for Progression and Therapy

Non-small cell lung cancer (NSCLC) is regarded as the most prevalent form of lung cancer, accounting for approximately 85% of all cases worldwide. This type of cancer is highly affected by the tumour microenvironment (TME), where exosomal communication is a major contributor. This prompts ongoing exploration of exosomes as therapeutic tools. Research into exosome-derived biomarkers, such as miRNAs, lncRNAs, and proteins, continues because their potential in drug delivery and immunotherapy can improve NSCLC treatment. This review explored the role of exosomal communication in the NSCLC tumour microenvironment, focusing on its impact on tumour progression, immune modulation, angiogenesis, and therapy resistance. Additionally, it evaluates the potential of exosomes as biomarkers for early diagnosis and therapeutic targets in NSCLC. A comprehensive literature review was conducted using peer-reviewed studies from databases such as PubMed, Google Scholar, and Web of Science. Articles were selected based on relevance to NSCLC and exosomal communication, with focus on studies published within the last five years. Both experimental and clinical studies were analyzed to provide a well-rounded understanding of exosome-mediated mechanisms in NSCLC. Exosomes contribute to NSCLC progression by promoting tumor-stromal interactions, modulating immune responses, and enhancing angiogenesis. Tumour-derived exosomes induce cancer-associated fibroblast activation, macrophage polarization, and suppression of cytotoxic T cells, creating an immunosuppressive microenvironment which promotes cancer growth. Exosomal communication plays a critical role in NSCLC pathogenesis, influencing tumour progression, immune evasion, and angiogenesis. This presents it as a great tool to be used as biomarker for predicting tumour progression. Future research should focus on refining exosome-based diagnostic and therapeutic strategies, paving the way for personalized medicine in NSCLC management.