Why do some cancers fail treatment from the very beginning? In this episode of the ARTNet Podcast, Dr. David Goodrich speaks with Dr. Vlad C. Sandulache of Baylor College of Medicine about emerging research showing that many tumors may already be biologically primed to resist therapy before treatment even starts. Together, they explore how oxidative stress, metabolism, immune interactions, and environmental exposures shape tumor behavior, discuss the role of the NRF2 pathway in treatment resistance, and examine how these insights could lead to better biomarkers and more personalized treatment strategies for patients with head and neck cancer.