Over the past decade, precision medicine has made significant advances in oncology, particularly through the use of targeted therapies designed to hit cancer cells precisely while minimizing the off-target effects of traditional treatments. A promising new avenue in cancer therapy involves the use of natural nanoparticles, extracellular vesicles (EVs), which play a crucial role in intercellular communication. With their inherent ability to transport molecules and their potential for precise targeting, EVs hold great promise for drug delivery. Here we explore the latest advancements in utilizing EVs for targeted cancer therapies, examining their surface features for targeting, engineering strategies to enhance their effectiveness, and the challenges and opportunities in customizing EVs for cancer treatment.