Exosomal long non-coding RNAs (lncRNAs) are emerging as important players in cancer biology, playing roles in tumor progression, metastasis, and immune modulation. These lncRNAs are carried within extracellular vesicles (exosomes) and facilitate communication between tumor cells and their microenvironment, making them valuable biomarkers for liquid biopsy. Exosomal lncRNAs are stable and can cross the blood-brain barrier, offering potential for non-invasive cancer diagnosis and treatment. They are involved in various processes, including tumor invasion, angiogenesis, and metastasis, by regulating gene expression through mechanisms such as competing endogenous RNA (ceRNA) and miRNA sponging. Exosomal lncRNAs also contribute to therapy resistance by modulating signaling pathways and enhancing tumor cell survival. In addition, they play a role in immunomodulation by influencing immune cell function and promoting tumor immune evasion. Exosomal lncRNAs are being explored as therapeutic targets and carriers for personalized cancer treatments. Despite their potential, challenges remain in understanding their mechanisms and improving their clinical utility. Advances in RNA-based therapeutics, including antisense oligonucleotides (ASOs) and exosome-based delivery systems, offer promising strategies for targeting exosomal lncRNAs in cancer treatment. Exosomes are being studied as efficient carriers for delivering therapeutic RNAs, such as miRNAs and lncRNAs, to cancer cells. The development of exosome-based therapies is an exciting area of research with potential for improving cancer outcomes.Exosomal long non-coding RNAs (lncRNAs) are emerging as important players in cancer biology, playing roles in tumor progression, metastasis, and immune modulation. These lncRNAs are carried within extracellular vesicles (exosomes) and facilitate communication between tumor cells and their microenvironment, making them valuable biomarkers for liquid biopsy. Exosomal lncRNAs are stable and can cross the blood-brain barrier, offering potential for non-invasive cancer diagnosis and treatment. They are involved in various processes, including tumor invasion, angiogenesis, and metastasis, by regulating gene expression through mechanisms such as competing endogenous RNA (ceRNA) and miRNA sponging. Exosomal lncRNAs also contribute to therapy resistance by modulating signaling pathways and enhancing tumor cell survival. In addition, they play a role in immunomodulation by influencing immune cell function and promoting tumor immune evasion. Exosomal lncRNAs are being explored as therapeutic targets and carriers for personalized cancer treatments. Despite their potential, challenges remain in understanding their mechanisms and improving their clinical utility. Advances in RNA-based therapeutics, including antisense oligonucleotides (ASOs) and exosome-based delivery systems, offer promising strategies for targeting exosomal lncRNAs in cancer treatment. Exosomes are being studied as efficient carriers for delivering therapeutic RNAs, such as miRNAs and lncRNAs, to cancer cells. The development of exosome-based therapies is an exciting area of research with potential for improving cancer outcomes.