Extracellular vesicles (EVs) are increasingly recognized as fundamental mediators of intercellular communication, a process conserved across all kingdoms of life. Compelling evidence demonstrates their involvement in diverse physiological and pathological contexts, including cellular homeostasis, infection propagation, cancer progression, and cardiovascular disease. Their natural ability to transport bioactive molecules provides several advantages over conventional synthetic carriers, such as enhanced biocompatibility, reduced immunogenicity, and intrinsic targeting capacity, positioning EVs as promising candidates for next-generation drug delivery systems. However, despite significant advances in preclinical research, the clinical translation of EV-based therapeutics remains challenging. Key barriers include the development of efficient and reproducible cargo-loading methods, rigorous characterization of heterogeneous vesicle populations, and scalable manufacturing processes that meet regulatory standards. Addressing these issues is critical to unlock the full therapeutic potential of EVs. This review highlights the distinctive biological features of extracellular vesicles (EVs) and outlines key considerations for their development as drug delivery systems. Special attention is given to novel approaches for therapeutic cargo loading, advanced methods for vesicle characterization, and strategies for scalable production. In cancer therapy, EVs have gained prominence due to their ability to transport bioactive molecules, influence the tumor microenvironment, and deliver anticancer agents with high specificity. Their natural biocompatibility, reduced immunogenicity, and capacity to cross biological barriers provide clear advantages over synthetic carriers, positioning them as promising tools for precision oncology. However, challenges such as vesicle heterogeneity, lack of standardized isolation protocols, and regulatory complexities continue to hinder clinical translation. To contextualize their potential, this review compares EV-based systems with established liposomal technologies, highlighting both strengths and limitations. By synthesizing current evidence and identifying future directions, we aim to provide a roadmap for advancing EV-based drug delivery platforms, particularly in cancer treatment, and accelerating their transition into effective clinical applications.