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Emerging roles of exosomes in diagnosis, prognosis, and therapeutic potential in ovarian cancer: a comprehensive review

Cancer Gene Therapy volume 32, pages 149–164 (2025)Cite this article

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Abstract

Ovarian cancer is a leading cause of cancer-related deaths in women, and the development of chemoresistance remains a major challenge during and after its treatment. Exosomes, small extracellular vesicles involved in intercellular communication, have emerged as potential biomarkers and therapeutic targets in ovarian cancer. This review summarizes the current literature on differences in exosomal protein/gene expression between chemosensitive and chemoresistant ovarian cancer, and the effects of exosomal modifications on chemotherapeutic response. Clinical studies have identified alterations in several exosomal components from ovarian cancer tissues and serum samples arising as a consequence of chemosensitivity, which indicates their potential usefulness as potential biomarkers for predicting the development of chemoresistance. Interventional investigations from in vitro and in vivo studies demonstrated that modulation of specific exosomal components can influence ovarian cancer cell phenotypes and individual responses to chemotherapy. Exosomal delivery of chemotherapeutic agents, such as cisplatin, has presented as a potential targeted drug delivery strategy for overcoming chemoresistance in preclinical models. In summary, this review highlights the potential for exosomal proteins and genes to be useful biomarkers for predicting chemotherapy response and being therapeutic targets for overcoming chemoresistance in ovarian cancer. However, future research is still needed to validate these findings and explore the clinical utility of exosomal biomarkers and therapeutics in ovarian cancer management. In addition, understanding the molecular mechanisms underlying exosome-mediated chemoresistance may provide valuable insights for the development of personalized therapeutic strategies, improving outcomes for patients with ovarian cancer.

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Fig. 1: A summary of the mechanisms employed by modulating exosomal proteins and genes on chemosensitivity in chemotherapy-treated ovarian cancer.

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Funding

This work was supported by the Distinguished Research Professor Grant from the National Research Council of Thailand (N42A660301: SCC); the Research Chair Grant from the National Research Council of Thailand (N42A670595: NC); and the Chiang Mai University Center of Excellence Award (NC); National Research Council of Thailand (N42A660432: NA).

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Thunwipa Tuscharoenporn & Kittipat Charoenkwan

  2. Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Nattayaporn Apaijai, Nipon Chattipakorn & Siriporn C. Chattipakorn

  3. Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand

    Nattayaporn Apaijai, Nipon Chattipakorn & Siriporn C. Chattipakorn

  4. Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Nattayaporn Apaijai & Nipon Chattipakorn

  5. The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand

    Nipon Chattipakorn

  6. Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand

    Siriporn C. Chattipakorn

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  1. Thunwipa Tuscharoenporn
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  2. Nattayaporn Apaijai
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  3. Kittipat Charoenkwan
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Contributions

TT: conceptualization, data curation, formal analysis, writing—original draft, writing—review & editing. NA: conceptualization, visualization, writing—review & editing. KC: conceptualization, visualization, writing—original draft, writing—review & editing. NC: conceptualization, visualization, funding acquisition, writing—review & editing. SCC: conceptualization, visualization, funding acquistion, supervision, writing—review & editing.

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Correspondence to Siriporn C. Chattipakorn.

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Tuscharoenporn, T., Apaijai, N., Charoenkwan, K. et al. Emerging roles of exosomes in diagnosis, prognosis, and therapeutic potential in ovarian cancer: a comprehensive review. Cancer Gene Ther 32, 149–164 (2025). https://doi.org/10.1038/s41417-025-00871-2

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