Exosome-Mediated Ferroptosis Regulation in Gastric Cancer: Mechanisms, Challenges, and Therapeutic Potential

Gastric cancer (GC) persists as one of the foremost contributors to cancer-associated morbidity and mortality worldwide, with limited effective therapies for advanced disease stages. Recent progress in cancer biology has spotlighted ferroptosis__an iron-dependent, regulated mode of cell death__as a promising avenue for therapeutic intervention. Exosomes__small extracellular vesicles that mediate intercellular communication__have emerged as pivotal modulators of ferroptosis through the transfer of bioactive molecules such as lipids, proteins, and RNAs. In the context of GC, exosomes influence critical metabolic pathways including iron homeostasis, oxidative stress, and lipid peroxidation, thereby contributing to tumor progression, metastasis, and therapeutic resistance. This review endeavors to comprehensively elucidate the current understanding of exosome-mediated ferroptosis regulation in gastric cancer, delineate the underlying molecular mechanisms, and to assess their potential as novel diagnostic and therapeutic targets. The review further highlights existing knowledge gaps and suggests.