Traditional tumor treatment methods lack sufficient targeting and can cause serious side effects. Exosomes are natural nanovesicles that carries a variety of biomolecules such as nucleic acids, proteins, metabolites, etc. They participate in intercellular communication and serve as drug delivery carriers with exceptional performance advantages, including low immunogenicity, low toxicity, and the ability to traverse natural barriers. However, targeting ability of exosome-based drug delivery systems is still insufficient. Aptamer is a class of chemically synthesized single-stranded nucleic acid molecules, which have the characteristics of small molecular mass, easy modification and low immunogenicity, and can be used as affinity ligands to specifically bind to targeted molecules. Aptamer-modified exosomes can precisely deliver drugs to the site where tumor cells occur, thereby achieving targeted treatment of tumors, enhancing the effectiveness of tumor therapy, and reducing adverse effects. Aptamers can modify exosomes in a variety of ways, mainly including receptor-ligand binding, hydrophobic interactions, DSPE-PEG2000-Mal conjugation, amide bonding, click chemistry, which lays a solid foundation for the development and application of aptamer functionalized exosome drug delivery systems. At present, the aptamer functionalized exosome drug delivery system still faces the following problems, such as the difficulty of aptamer screening, the low efficiency of exosome isolation and purification, and the lack of safety research on the use of aptamer-functionalized exosomes as drug-targeting delivery systems. As long as the above problems are solved, the role of aptamer functionalized exosomes in the treatment of tumors can be maximized. This review will focus on the application of aptamer functionalized exosome drug targeting delivery systems in various tumor treatments, and elaborate on their future challenges and opportunities.