Abstract
Bladder cancer remains a significant global health challenge, requiring repeated treatments and surveillance and potentially morbid therapies, particularly in advanced and recurrent stages. Exosomes, small extracellular vesicles central to intercellular communication, have emerged as innovative tools in cancer diagnostics, prognosis, and therapy. Their role in modulating the immune response and the tumor microenvironment makes them particularly attractive for cancer immunotherapy. This review provides a comprehensive overview of exosome biology, with a focus on their role in immune modulation and potential therapeutic applications. We explore the progress and challenges of exosome-based immunotherapy in cancer, followed by a discussion on the current state of bladder cancer immunotherapy. Additionally, we highlight the roles of exosomes in bladder cancer, emphasizing their diagnostic and prognostic applications. Despite promising preclinical studies and a growing number of clinical trials in other cancers, exosome-based therapies remain underexplored in bladder cancer. We discuss the current clinical trials related to exosomes in bladder cancer and propose their potential future role in immunotherapy. Finally, we address the challenges and opportunities in translating exosome-based therapies from bench to bedside, emphasizing the need for further preclinical and clinical investigations. This review emphasized the potential of exosome-based immunotherapy as a transformative approach for bladder cancer diagnosis and treatment.