Extracellular vesicle-associated therapeutic radiopharmaceuticals for cancer: Current advances and translational perspectives.

Authors

Ye Ri Han, Sang Bong Lee

Published in

Colloids and surfaces. B, Biointerfaces. Volume 270. Pages 116285. Oct 29, 2026. Epub Oct 29, 2026.

Abstract

Extracellular vesicles (EVs) are biologically active carriers whose membranes and luminal cargo may support radionuclide delivery, intracellular co-delivery, or indirect sensitization to radionuclide treatment. However, direct therapeutic evidence remains limited to heterogeneous preclinical studies. This critical narrative review separates radionuclide-bearing EV therapy from diagnostic tracking, EV-mediated delivery of the sodium iodide symporter, boron neutron capture therapy, and radiation-induced EV signaling. A focused literature update and study-level assessment are organized around radionuclide location, carrier integrity, absorbed dose, and manufacturability. Newly incorporated therapeutic and functional-integrity studies demonstrate opportunities for combined delivery while exposing the limits of inferring benefit from labeling performance. High radiochemical purity, persistent tissue radioactivity, and preserved particle size do not independently establish functional EV delivery. Total absorbed-dose calculations must include released radionuclides and radioactive metabolites; intact-EV attribution addresses a different mechanistic question. Comparisons at matched administered activity should be supplemented, where feasible, by matched tumor dose, matched normal-organ exposure, or equitoxic comparisons. EV complexity is most defensible when a specific biological delivery function produces a measurable benefit that simpler carriers cannot provide. We propose product-specific development decisions rather than universal release thresholds. Immediate priorities are controlled therapeutic comparisons, validated assays at intended activity concentrations, adequately sampled tumor and organ kinetics, and reproducible functional potency. Available evidence does not establish a general therapeutic-index advantage or clinical readiness for EV-associated radiopharmaceuticals.

PMID:
42966092
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.

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