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Recent advances in molecular oncology have identified exosomes, nanoscale extracellular vesicles with diameters of 30\u2013150\u2005nm, as pivotal mediators of the lateral transmission of bioactive molecular signals. This review provides a high-level synthesis of exosomal biogenesis and the nuanced roles these vesicles play in lung cancer. Specifically, we discuss how tumor-derived exosomes orchestrate remodeling of the tumor microenvironment, facilitate premetastatic niche formation, and drive immune evasion via the programmed death-1\/programmed death-ligand 1 axis and recruitment of regulatory cells. A significant portion of this review is dedicated to exosomal noncoding RNAs, including microRNAs, long noncoding RNAs, and circular RNAs, emphasizing their stability as liquid biopsy substrates and their involvement in cross-resistance to tyrosine kinase inhibitors and immunotherapies. 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