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Predictive Clinical Features and Molecular Markers for Tumor Response and Treatment Outcomes Post-NACT in HPV-negative Oral Cancers

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Head and neck squamous cell carcinomas (HNSCCs) is a complex and heterogeneous disease regulated at multiple levels and associated with high mortality and morbidity. HNSCCs are related to environmental risk factors, especially excessive tobacco and alcohol consumption. Oral squamous cell carcinomas (OSCCs) are the prevalent forms of HNSCC, representing approximately 90% of all tumors in this region. The high mortality associated with OSCC is related mainly to the locoregional advancement of the disease. Although significant improvements have been made in achieving local control of the disease and increasing the survival rate of patients with primary malignant oral tumors via surgical intervention, physicians face yet another challenge—that of preserving oral functions, such as articulation, mastication, and deglutition, and retaining visual aesthetics for improving HNSCC patients' quality of life. Effective treatment for advanced HNSCC (T3 and T4), but non-resectable tumors involves the use of multidisciplinary therapies, such as multiple chemotherapies (CTs) and radiotherapy (RT). However, most patients present in an advanced stage, wherein tumor resection is rendered questionable because of the positive resection margins. The prognosis of such unresectable stage IVA or IVB tumors treated with a non-surgical approach is poor, with median survival ranging from 2 to 12 months. for these locally advanced borderline operable cases, where the role of neoadjuvant chemotherapy (NACT) has been postulated as an alternative to the current existing therapeutic modalities. Although NACT provides a promising scenario for managing this patient subgroup, it should be known that response rates to this modality vary from 35-40%. Although NACT has been evaluated over the last decade, the chemoresistance phenomenon and its molecular mechanisms are yet to be studied comprehensively. There exists a need to identify biomarkers that will help us in better therapeutic stratification of these patients. There has been no study focusing specifically on the markers to predict response in oral cavity cancers, which is the aim of the present study.

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