by Clio Holman
The Ann Richards School for Young Women Leaders, Austin, TX
Second Place
At the most basic level, an engineer is a problem solver—someone who identifies a problem and works to find or create a solution. Engineering is a great opportunity for intervention and improvement; engineers have the means to change the world. But with this potential comes the possibility of making mistakes, and the responsibility of engineers to make sure that their ideas and solutions do no harm.
One illustration of this potential is cancer. Cancer is a universal affliction—and mystery—that has been explored since the beginning of modern medicine. Scientists, doctors, and engineers have struggled for decades to find out how to stop a disease that seems to appear out of nowhere.
Efforts to cure the disease or stop its progression have been hindered by a lack of understanding of the origins of cancer and by the negative effects on the human body of traditional cancer treatments. Chemotherapy, the most commonly used treatment, cannot specifically target cancer cells, leading to overall cell death. This form of treatment, while the most advanced and effective we have, can negatively affect many body systems and processes and can cause unpredictable side effects. However scientists may have found an alternative solution, one that will more directly affect cancer cells.
Cancer is an abnormal growth of cells in the body. In order to grow and survive, all cells need a source of oxygen and nutrients which are transported by blood vessels. In a normal body, the process of 'angiogenesis' allows new blood vessels to form. This is a natural process brought on by signals from the body when injury or other circumstances require. These new blood vessels allow for regrowth and healing. Cancer cells, in the form of a tumor, hijack this system, signaling the body to create new (albeit immature) blood vessels which supply the tumor and allow it to grow and metastasize (spread to other parts of the body through the bloodstream).
The creation of these new blood vessels can be prevented by 'angiogenesis inhibitors', natural products found in the body or obtained through diet that interrupt the creation of new blood vessels. These chemical signals can stop the activation of VEGF (vascular endothelial growth factor), which tells the body to start angiogenesis, or prevent the production of VEGF by blocking signals from endothelial cells (which are found in existing blood vessels).
Most solid tumors rely on angiogenesis to progress; a defecit of angiogenesis inhibitors allows for unrestricted cancer growth. Angiogenesis inhibitors have been shown to slow tumor growth and extend patient life, as well as effectively treat previously unresponsive tumors (such as those in glioblastoma, a type of brain tumor).
The discovery of these inhibitors has proven to be of major importance to biomedical engineers and researchers, who are exploring how the use of these inhibitors can slow cancer growth, prevent metastasis, and thus improve a cancer patient’s prognosis. They have developed drugs, both synthetic and natural, that accomplish this. The FDA has approved one such drug for use, bevacizumab, and others are in clinical trials.
This technology has tremendous potential to help a patient fight cancer while maintaining body function and a nearly normal lifestyle, because angiogenesis inhibitors do not affect healthy cells. By using a natural process to help fight cancer, we may be able to improve the lives of those living with cancer and extend patient life span, an important aspect of treatment today.
However promising, this engineering development presents its own complications and limitations. These must be confronted by all medical professionals and engineers. Although a potentially life-saving technology has been developed, questions of effectiveness, access, application and cost must be addressed.
First, angiogenesis inhibitors do not kill cancer; they only stop its growth. Also, since the process of angiogenesis is critical to many body processes (such as wound healing and heart/kidney function), the drugs can compromise these, as well as trigger symptoms such as excessive bleeding, blood clots in arteries (arterial embolism), hypertension, and protein in the urine. All of these can lead to further issues. Luckily, these side effects are rarely serious and can usually be managed. As a precaution, clinical trials are currently testing the efficacy of combining angiogenesis inhibitor treatment with other blood vessel treatments, in the hope that one will offset the other and prevent or decrease side effects. Those developing these medications will have to weigh the risk of potential harm against the promise of successful treatment.
As an engineer of this emerging technology, I would remain committed to eliminating the negative side effects of treatment, whether through altering the technology or developing an effective means to neutralize symptoms.
Second, this engineering advance faces the issue of fair distribution, in this case global access to the drug by those who need it. Of all the anti-angiogenic therapy drugs listed by Samant and Shevde in their article "Recent Advances in Anti-Angiogenic Therapy of Cancer", nearly all were produced in the United States or Europe and few were available outside of the United States. According to the International Network for Cancer Treatment and Research, the majority of cancer deaths occur in lower- and moderate-income countries (72% in 2008). This is due to delays in diagnosis, lack of optimal or appropriate treatment, and lack of palliative care (early assessment and treatment of symptoms in the presence of a long-term or incurable illness). This inequity is disturbing, and challenges engineers to improve the system.
Third, the cost of bio-engineered angiogenesis inhibitors may prevent even those with medical insurance and access to the drugs from benefiting from them. In a 2013 study, "The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient's Experience", the authors found that among 254 participants, 40% of participants “reported a significant or catastrophic subjective financial burden”. They identified a need for further research into how to alleviate these financial challenges, which can often take up more than an individual or family’s yearly income. Patients in lower-income countries are unlikely to be able to pay the costs of cancer treatment at all. For many in this situation it may be easier and much less costly to let the disease run its course.
A balance must be found between the cost of developing and testing these medications and the right to access medical treatment. As an engineer working on this potentially life-changing technology, I would work to find equity between the considerable investment of time and resources in drug development and the global need for cancer treatment and care.
Synthetic angiogenesis inhibitors have the potential to improve life for all human beings, and should not be limited to those countries and individuals who can afford the cost. I would advocate for programs and public policies that recognize the need for engineers and the companies they work for to recoup the costs of their investment in research and development, while also recognizing that access to needed medical care should be a human right.
Ultimately, the development of synthetic angiogenesis inhibitors may provide a long-sought remedy for one of the most common diseases in the world. Despite this, engineers and other scientists still have work to do to ensure that the technology they have created addresses the problem in a physically, economically, and environmentally responsible way. These challenges can be solved or improved upon, but only by examining the issues I have described above.
References:
Angiogenesis Inhibitors Therapy: Questions and Answers [Fact sheet]. (2007, December 6). Retrieved from CancerNews website: http://www.cancernews.com/data/Article/610.asp
Cancer in Developing Countries. (n.d.). Retrieved January 4, 2016, from International Network for Cancer Treatment and Research website: http://www.inctr.org/about-inctr/cancer-in-developing-countries/
National Cancer Institute. (2011, October 7). Angiogenesis Inhibitors [Fact sheet]. Retrieved January 1, 2016, from National Cancer Institute website: http://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet
Samant, R. S., & Shevde, L. A. (2011). Recent Advances in Anti-Angiogenic Therapy of Cancer. Oncotarget, 2(3), 122–134.
Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., Zhong, X., & Abernethy, A. P. (2013). The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient's Experience. The Oncologist, 18(4), 347-349. Retrieved from http://theoncologist.alphamedpress.org/content/18/4/381.abstract#cited-by