Exosomes, nanosized vesicles secreted by cells, are gaining significant attention in biomedical research due to their biocompatibility, cargo loading capacity, and deep tissue penetration. They serve as natural signaling agents and can carry proteins, lipids, and nucleic acids, making them promising for various therapeutic applications such as chemotherapy, gene therapy, and photothermal therapy. Despite their advantages, challenges remain in optimizing cargo loading efficiency, structural stability, and defining exosome origins. Future research should focus on developing large-scale, quality-controllable production methods, refining drug loading strategies, and conducting extensive in vivo studies and clinical trials. This review highlights recent advances in exosome-based drug delivery systems, emphasizing their unique properties and therapeutic potential while addressing key challenges and future directions. The use of exosomes as efficient, stable, and safe therapeutic delivery systems is an exciting area in biomedical research, and further development of exosome-based drugs is encouraged for clinical application.Exosomes, nanosized vesicles secreted by cells, are gaining significant attention in biomedical research due to their biocompatibility, cargo loading capacity, and deep tissue penetration. They serve as natural signaling agents and can carry proteins, lipids, and nucleic acids, making them promising for various therapeutic applications such as chemotherapy, gene therapy, and photothermal therapy. Despite their advantages, challenges remain in optimizing cargo loading efficiency, structural stability, and defining exosome origins. Future research should focus on developing large-scale, quality-controllable production methods, refining drug loading strategies, and conducting extensive in vivo studies and clinical trials. This review highlights recent advances in exosome-based drug delivery systems, emphasizing their unique properties and therapeutic potential while addressing key challenges and future directions. The use of exosomes as efficient, stable, and safe therapeutic delivery systems is an exciting area in biomedical research, and further development of exosome-based drugs is encouraged for clinical application.