Exosome as non-invasive prognostic and diagnostic biomarker and nanovesicle for targeted therapy of non-small cell lung carcinoma

Despite enormous evolution in oncopharmacology, the non-small cell lung carcinoma (NSCLC) is still among the most aggressive and prevalent types of cancer. Late diagnosis and poor prognosis are among the various predisposing factors associated with low disease-free survival (DFS) and overall survival (OS) rates in NSCLC patients. Being a stable source of tumor-derived antigens, exosomes and exosomal components (e.g., miRNAs, lnRNAs, circRNAs, cDNA, or proteins) can be actualized as a next-generation diagnostic/prognostic marker for early diagnosis and prognosis of NSCLC. Extensive research has been done on invasive screening of NSCLC through solid biopsy, but the prime focus of this review is non-invasive screening of NSCLC through liquid biopsy. The genetic and proteomic dysregulation of exosomal components in various biofluids precisely correlates with cancer growth, metastasis, stagging, chemoresistance, recurrence, low DFS and OS rates, and poor prognosis of NSCLC. Owing to their unique functionalities inherited from the source cells, protection of drug(s) from degradation, and nanoscaled dimensions (50-150 nm), exosomes have also been exploited for targeted delivery of a variety of drugs to NSCLC cells/tissues. Exosomal nanotherapeutics have shown exceptional anticancer efficacy against NSCLC due to enhanced cell uptake, higher cytotoxicity, mitigated proliferation and migration, prolonged plasma half-life, specific biodistribution, and controlled release of antineoplastic agents. Despite holding great promise, more research needs to be done before translating the exosome-mediated diagnosis/ prognosis and treatment of NSCLC to clinical settings. In addition, standard guidelines/protocols for isolation, purification, production, and quality control of exosomes need to be formalized for manufacturing of clinicalgrade exosomes.