Pivotal role of exosomes in diagnosis and treatment of esophageal cancer in a new era of precision medicine

Abstract

In this editorial we comment on the article published by Ning et al, “Role of exosomes in metastasis and therapeutic resistance in esophageal cancer”. Esophageal cancer (EC) represents a significant global health concern, being the seventh most common and sixth in terms of mortality worldwide. Despite the advances in therapeutic modalities, the management of patients with EC remains challenging, with a 5-year survival rate of only 25% and a limited eligibility for curative surgery due to its late diagnosis. Conventional screening methods are impractical for the early detection of EC, given their either invasive or insensitive nature. The advent of liquid biopsy, with a focus on circulating tumor cells, circulating tumor DNA, and exosomes, heralds a non-invasive avenue for cancer detection. Exosomes, small vesicles involved in intercellular communication, are highlighted as potential biomarkers for EC diagnosis and prognosis. Along with a diverse cargo encompassing various types of RNA, DNA molecules, proteins, and metabolites, exosomes emerge as key players in tumorigenesis, tumor development, and metastasis. Their significance extends to carrying distinctive biomarkers, including microRNAs (miRNAs), long non-coding RNAs, and circular RNAs, underscoring their potential diagnostic and prognostic value. Furthermore, exosomes may be utilized for therapeutic purposes in the context of EC treatment, serving as efficient delivery vehicles for therapeutic agents such as chemotherapeutic medicines and miRNAs. In this editorial we delve into the applications of exosomes for the early detection and treatment of EC, as well as the future perspectives.

Keywords: Exosomes; Esophageal cancer; Diagnostic methods; Novel therapies

Core Tip: Esophageal cancer (EC) is a global health concern ranking seventh in incidence and sixth in mortality worldwide, with over 604000 new cases and 544000 deaths in 2020. Despite advancements in therapies, nearly half of EC patients experience distant metastasis or therapeutic resistance, resulting in a 5-year survival rate below 25%. Traditional screening methods are limited, necessitating the need for non-invasive alternatives. Liquid biopsy, particularly focusing on exosomes, emerges as a promising option for early EC detection. Exosomes, small vesicles for intercellular communication, carry diverse biomarkers and play a crucial role in tumorigenesis. Notably, exosomal microRNAs, long non-coding RNAs, and circular RNAs show potential as diagnostic and prognostic markers for esophageal squamous cell carcinoma. Beyond diagnosis, exosomes serve as effective delivery tools for therapeutic agents, exhibiting advantages in immunotherapy, gene therapy, and drug delivery, presenting a multifaceted approach in the battle against EC.