ENGR 0011 Budny 10:00
Group R12
Ethics in Oncolytic Virotherapy
Kristen Byrd (krb116@pitt.edu)
INTRODUCTION
Around 1950, many scientists had began thinking of
the concept of using viruses to treat illnesses such as cancer.
They developed models and tested their theories of oncolytic
viruses to sick patients. Oncolytic viruses are viruses that
have a natural tendency to infect and terminate cancerous
cells without harming healthy tissue. Initially, doctors noticed
that the viruses didn’t reduce tumor size, but as the treatment
proceeded for a while the size of the tumor was reduced
especially in immunosuppressed patients. Although this new
idea of using viruses to cure worked, many of these patients
died once the virus spread to healthy tissues. Remember, that
was 1950 and technology was not nearly as advanced as it is
today.
For many years following, the most common method
of treating cancer was chemotherapy. In this method of
treatment, cytotoxic agents are injected into the patient.
Essentially, these agents are responsible for destroying any
cell that divides at a rapid rate. The problem with cytotoxic
agents destroying all cells increasing in number at a fast rate
is that the normal cells that naturally multiply quickly are also
destroyed including but not limited to hair follicles and bone
marrow. As a result, the patient gains many other problems
while trying rid of another problem.
Overall, chemotherapy is a destructive method to rid
sick patients of cancer. This has lead many researchers to find
another method to treat cancer. As of 2015, Amgen’s was set
to become the first oncolytic virus to gain approval with a 221 vote. This virus was designed specifically to target
cancerous cells within Melanoma cancer patients. T-Vec is a
very potent, genetically modified version of the herpes
simplex virus 1.
SCENARIO: ELIZABETH
In addition to melanoma, [2] the herpes simplex
virus is also used to treat cancers of the central nervous system
such as malignant gliomas. Survival of malignant glioma is
about four to twelve months following the diagnosis.
17-year-old patient Elizabeth Haynes was diagnosed
of stage three malignant glioma on March 5, 2015 at the
UPMC. She was told that she had about five months to live if
left untreated; However, the oncologist gave her hope and told
her her situation had a possibility of reversing itself. He talked
to her about her options in terms of treatment which included
surgery to completely remove the tumor from her brain,
University of Pittsburgh, Swanson School of Engineering 1
Submission Date 2015-11-3
chemotherapy, oncolytic virotherapy with the herpes simplex
virus, or oncolytic virotherapy with chemotherapy.
Unfamiliar with oncolytic virotherapy, she asked what the
treatment consisted of. The doctor explained to her that there
were many oncolytic viruses such as parvovirus, reovirus,
Newcastle disease virus, mumps virus and Moloney leukemia
virus which are all naturally preferential and measles,
adenovirus, vesicular stomatitis virus(VSV), and vaccina and
herpes simplex virus(HSV) which are all genetically
modified. The specific virus Elizabeth would be receiving is
known as the herpes simplex virus. She was ensured that this
virus is genetically modified to fit her needs in order to rid her
body of cancer. Although hesitant about the pros and cons of
the innovative treatment, Elizabeth and her mother both
decided that it was best for Elizabeth to receive the oncolytic
virotherapy. With oncolytic virotherapy, she would be in the
least amount of pain while dealing with her unfortunate
situation. After about a week’s worth of treatment, the doctors
performed standard tests to see if any progress was made.
Upon getting her blood drawn, the assistant noticed sores on
her arm. Immediately, she called for the oncologist to view
her arm and myself to provide any information and possible
solutions. He took a step back and said, “I am sorry, Elizabeth
but it seems as though the herpes simplex virus has spread to
your healthy tissues. Fortunately, we can reverse the infection
present with an anti-HSV drug. The thymidine kinase present
will stop replication of the herpes virus and shut it off.
However, now it is up to you and your mother to decide if you
want to continue with this treatment or choose one of the other
options I gave you last week”. On one hand, in Elizabeth’s
mother’s mind, the only other viable option was
chemotherapy; however, if Elizabeth was given
chemotherapy, her mother could only afford to provide her
daughter with about four and a half months’ worth of
treatment, which leaves a few weeks of her being left
untreated hoping that the cancer would leave her body
completely. On the other hand, Elizabeth knew of the side
effects that were associated with chemotherapy such as hair
loss, fatigue, and a suppressed immune system. She did not
want to endure any of these side effects. In addition, prom
season was approaching and if she were to survive she didn’t
want to arrive at prom in an awful condition. She explained
her desires to her mother with the oncologist and myself
present in the room. I felt bad for this poor teenage girl. Prom
is every high schooler’s dream. Regardless of Elizabeth’s
wishes, she was a minor and her mother could override any
decision Elizabeth made. After about 30 minutes of Elizabeth
trying to convince her mother not to switch to chemotherapy,
her mother decided to choose chemotherapy as her alternative
Kristen Byrd
treatment. The oncologist and I stepped out of the room and
he said, “I would like you to engineer a new herpes simplex
virus in no longer than two months. I want you to test this new
version on an animal model for at least week and make sure
that it is done right”. I nodded at him and said “Okay”.
miscommunication occurs, there is an increase in the chance
of bad things happening to anything and anyone. Like stated
above, I can perform services only in areas of their
competence meaning that I can talk about the information in
my area of expertise. In addition, we need to consider who is
administering the virus and how they are administering the
virus. In this case, the oncologist’s assistant administered the
virus in a general hospital. I think that oncolytic virotherapy
should be administered at a specific location designated to
treat cancer. I believe if the location is more specific, the
patient will receive better treatment. Cancer is not a fun
experience, and if there were people whose focus and
specialty was just in administering the virus while making
their experience positive, that could make all the difference in
the world. A positive experience can lead to a release of good
chemicals throughout the body which might enhance a
person’s health which can lead to a more efficient recovery.
Therefore, engineers need to limit who we give our products
to. Although the who and how seem to be exterior to the
problem of the “poorly” engineered virus; however, I feel like
the little pieces can make a huge difference overall.
ETHICAL ISSUES
Overall we are dealing with ethical issues pertaining to
two different ideas: the patient and the animal model. Several
different factors must be considered before making the new
engineered herpes simplex virus such as where is the
treatment taking place, who is administering the oncolytic
viruses, and how are they storing the organisms. In addition
to maintaining good conditions for the oncolytic virus, we
must consider how the virus will affect the animal model that
is being tested in addition to what kind of environment the
animal is. We need to make sure that the conditions of the
animal model are a good representation of the patient’s
condition. There are other ethical issues such as the idea of
the mother overriding her daughter’s wishes in not proceeding
with the chemotherapy. If the patient is uncomfortable with
the idea of a certain procedure, they should not have to abide
by their parents wishes especially since she is so close to the
legal adult age of 18; However, that would be more of an
ethical issue to consider if I was the oncologist giving
approval for the treatments.
Ensured Quality
In addition to my theories of how the treatment could have
altered from its original intent due to poor care, I have to
ensure that the virus did not spread to the healthy tissues for
other reasons. Although the herpes simplex virus can be
treated with an anti-herpes simplex virus, the last idea we
would want to think about is if for whatever reason the virus
infects the cancerous cells and is engulfed inside of them.
Because cancer cells divide quickly the virus will spread and
infect at a faster rate. Considering that the patient’s immune
system is suppressed this could end fatally. This being said,
we must double check our process of engineering the virus to
ensure quality performance and document every step made in
making the virus
REVISION
Theory of Error
[1] According to NSPE Code of Ethics for Engineers, it is my
responsibility to: hold paramount the safety, health and
welfare of the public, perform services only in areas of their
competence, issue public statements only in an objective and
truthful manner, act for each employer or client as faithful
agents or trustees, avoid deceptive acts, and conduct myself
honorably, responsibly, ethically, and lawfully so as to
enhance the honor, reputation, and usefulness of my
profession.My thought is that the original virus administered
to the patient more than likely was engineered fine; however,
there is a possibility that it was not properly handled and as a
result the virus’s performance was altered. Considering the
different possibilities that could have altered the virus, my
first idea would be to engineer the new version of the herpes
simplex virus so that the environment the virus is positioned
in has no affect on its performance. Switching genes on and
off might allow this to work. In addition to this, I think a
conversation needs to take place with the doctors
administering the innovations the engineers produce. There
should be a common understanding of how different products
function and how they should maintain them. When
Ethics in Testing an Animal Model
Before testing the newly engineered virus on the animals,
another team needs to check our methods and approve them.
They also must approve the environment the animal model is
in. When working with the animal model, I need to make sure
the animal is living in good conditions. The animal needs to
be fed regularly, live in a comfortable environment, and be
treated with the virus gently and humanely. I think it is
important that the condition that the animal is in should reflect
that of the patient so the response to the virus is accurately
observed.
Financial Efficiency
Moreover, we are dealing with a family who cannot
necessarily afford to pay for these treatments. Since I am not
2
Kristen Byrd
[3] B Schrag (2002) “A DNA Dilemma” Online Ethics Center
for
Engineer
and
Science.
(Online
Article)
http://www.onlineethics.org/Resources/Cases/dilemma.aspx
authorized to do so, we need to have a team to find the most
efficient and affordable way to produce these oncolytic
viruses so the people we distribute them too can utilize this
method of treatment. Our product should not be designed to
help a certain type of people such as high class but instead
engineered for everybody everywhere.
[4] (2009) “It Only Takes a Second” WebGURU. (Online
Ethics Case Study)
http://www.webguru.neu.edu/professionalism/casestudies/it-only-takes-second
[5] Goldie, Kadushin, Egan, Marcia (2001) “Ethical
Dilemmas in Home Health Care” EBSCOhost. (Online
Article)
http://web.a.ebscohost.com/ehost/detail/detail?sid=cf32173c
-a57e-41ed-b2a6516cf03f1206%40sessionmgr4001&vid=1&hid=4114&bdat
a=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=50
97985
[6] R Macklin (2015) “The Ethical Dilemma of Forced
Chemotherapy on a Teen” Einstein.
http://blogs.einstein.yu.edu/the-ethical-dilemma-of-forcedchemotherapy-on-a-teen/
[7] C Klugman (2015) “The Democratic Debate on Health:
Not Much” Bioethics.net (Online blog)
http://www.bioethics.net/
CONCLUSION
I was given the task to produce a new engineered version of
the herpes simplex virus because the previous seemed to not
work on the patient. It spread to her healthy tissues and as a
result the oncologist reached the conclusion that the virus
given to Elizabeth were “poorly” engineered when in fact the
administration mishandled the viruses given to the patient.
After some thought we reached the conclusion that it was our
mistake of allowing the general hospital to administer the
virus. We did not consider the positive and negative effects
that it would have on the virus. After four weeks, my team
engineered a new and improved herpes simplex virus was
made and is now administered at the Noon Chapel Hill Cancer
Center. Elizabeth had been receiving chemotherapy for the
past four weeks. With the news of the new engineered herpes
simplex virus and the effect it had on the animal model, she
was able to convince her mother to let her switch to the
oncolytic virotherapy. After about a month of the additional
therapy her stage three malignant glioma completely reversed
itself and was cured. As a result, she was able to make it to
her prom with a few works of recovery. (2314).
ADDITONAL SOURCES
"Ethics Case Studies." WebGURU. (Online case report).
http://www.webguru.neu.edu/professionalism/researchintegrity/ethics-case-studies
(2009) "Cases and Scenarios." Online Ethics Center for
Engineering. National Academy of Engineering (online case
report). http://www.onlineethics.org/Resources/Cases.aspx
ACKNOWLEDGEMENTS
I would like to thank Dekwuan for pushing me to do complete
this assignment. I would also like to thank the Writing
Department for producing these creative writing assignments
that truly make me reflect why I want to do engineering. I
would also like to thank Pitt Excel for giving me ideas when
writer’s block took over.
REFERENCES
[1] (2015) “Code of Ethics.” National Society of Professional
Engineers. (Online code of ethics-pdf).
http://www.nspe.org/resources/ethics/code-ethics
[2] Y Shen, J Nemunaitis (2006) “Herpes simplex virus 1
(HSV-1) for cancer treatment.” EBSCOhost. (Online pdf)
http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=
0bda9726-3b3b-4655-9db77c154969b4d3%40sessionmgr4001&vid=33&hid=4209
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