Abstract: Breast cancer is the most prevalent malignancy among women, with triple-negative breast cancer (TNBC) being the most aggressive subtype. The lack of standard targeted therapies necessitates reliance on chemotherapy, which often suffers from poor targeting and significant off-target toxicity. This systematic review evaluates the therapeutic potential of drug delivery systems based on extracellular vesicles (EVs) for TNBC using 17 studies from 2020 to 2024 published in Scopus, PubMed, and Web of Science. The review discusses the diverse therapeutic cargos delivered by EVs, including chemotherapeutic agents and nucleic acids, while emphasizing the need for standardized protocols to facilitate EV isolation and characterization. Key findings provide both in vitro and in vivo evidence of the efficacy of EV-based therapies against TNBC cell lines and animal models, alongside insights into engineering strategies that enhance targeting specificity. Despite the promising findings, challenges remain in clinical translation, such as technical limitations and inconsistent reporting. The results underscore the potential of EVs to revolutionize TNBC treatment strategies, paving the way for more effective therapeutic options.