Advances in nanoscale materials have become indispensable for targeted drug delivery, early detection, and personalized approaches for cancer treatment. Among various nanoscale materials investigated, exosomes hold significant promise in drug delivery. Exosomes are nanoscale vesicles that are usually 30–150 nm in size and produced by cells for intercellular communication. Due to their unique composition and inherent tumor-targeting capacity, these particles are well suited for tumor-specific delivery systems. This chapter discusses exosome isolation, therapeutic loading methods, key roles of exosomes in the tumor microenvironment, current applications of exosomes in drug delivery, and possible clinical implications.