Engineered cell-based cancer therapies have shown promise but face challenges such as toxicity, cost, and side effects. In contrast, modified exosomes offer a cell-free, biocompatible, and non-immunogenic alternative. Exosomes, a type of extracellular vesicle, are derived from various sources including stem cells, plants, and immune cells. They can be chemically or genetically modified to enhance their therapeutic potential, targeting cancer cells specifically. Modified exosomes have shown significant potential in cancer therapy due to their ability to be surface-modified and loaded with therapeutic agents like DNA, RNA, drugs, and proteins. They are also less toxic and more efficient than engineered cells. However, challenges remain in their isolation, heterogeneity, and toxicity. Exosome-based therapies are supported by advanced technologies such as nanotechnology, multiomics, AI, and machine learning. Exosome barcoding is a simplified method for exosome screening. The integration of exosome biology and nanotechnology could revolutionize cancer precision medicine. Modified exosomes offer a promising platform for effective, efficient, and affordable cancer therapy compared to engineered cell-based approaches. Further research is needed to assess their safety and efficacy in clinical settings.Engineered cell-based cancer therapies have shown promise but face challenges such as toxicity, cost, and side effects. In contrast, modified exosomes offer a cell-free, biocompatible, and non-immunogenic alternative. Exosomes, a type of extracellular vesicle, are derived from various sources including stem cells, plants, and immune cells. They can be chemically or genetically modified to enhance their therapeutic potential, targeting cancer cells specifically. Modified exosomes have shown significant potential in cancer therapy due to their ability to be surface-modified and loaded with therapeutic agents like DNA, RNA, drugs, and proteins. They are also less toxic and more efficient than engineered cells. However, challenges remain in their isolation, heterogeneity, and toxicity. Exosome-based therapies are supported by advanced technologies such as nanotechnology, multiomics, AI, and machine learning. Exosome barcoding is a simplified method for exosome screening. The integration of exosome biology and nanotechnology could revolutionize cancer precision medicine. Modified exosomes offer a promising platform for effective, efficient, and affordable cancer therapy compared to engineered cell-based approaches. Further research is needed to assess their safety and efficacy in clinical settings.